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Ramesh U, Contrera KJ, Shakibai N, Su SY, Brahimaj B, Roberts D, Williams MD, Ferrarotto R, Phan J, Gunn GB, Raza S, DeMonte F, Hanna EY. Sinonasal NUT carcinoma: A consecutive case series and systematic review. Head Neck 2024; 46:29-36. [PMID: 37853958 DOI: 10.1002/hed.27553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Sinonasal NUT carcinoma is an extremely rare, lethal malignancy with limited literature. METHODS A case series was conduction of all patients with sinonasal NUT carcinoma at a single institution between 2010 and 2022. Survival and associated were evaluated. A systematic review of the literature was performed. RESULTS In 12 patients, followed for a median of 1.5 years, the median overall survival (OS) and disease-specific survival (DSS) were both 14.6 months. Patients with maxillary sinus tumors were 91% more likely to survive (hazard ratio [HR]: 0.094, 95% confidence interval [CI]: 0.011-0.78, p = 0.011). Patients with higher-stage disease stage had worse OS (stage IVb-c vs. III-IVa, p = 0.05). All three patients who were alive with no evidence of disease received induction chemotherapy. CONCLUSION For patients with sinonasal NUT carcinoma, the median survival was 15 months but better with lower-stage and maxillary tumors. Induction chemotherapy may be beneficial.
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Affiliation(s)
- Uma Ramesh
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Nasim Shakibai
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Bledi Brahimaj
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Dianna Roberts
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic-Head & Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gary Brandon Gunn
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shaan Raza
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Jimenez C, Stanton E, Kondra K, Nickels EM, Jacob L, Shah R, Hammoudeh JA. NUT carcinoma of the mandible in a child: case report and systematic review. Int J Oral Maxillofac Surg 2023; 52:304-312. [PMID: 35868909 DOI: 10.1016/j.ijom.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have an overall survival of approximately 5% at 5 years despite a multimodal treatment approach. This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. She remains disease-free 21 months after completion of therapy. A total of 63 patient cases reported in 34 articles were identified in the review. Only 26.9% (14/52) of tumors were correctly diagnosed initially as NUT carcinoma, whereas 73.1% (38/52) were incorrectly diagnosed as another malignancy; the initial diagnosis was not reported for 11 patients. The mandibular tumor subtype was among the rarest reported (n = 1; 1.6%). Combination therapy, including surgery and chemoradiation, was the most common treatment (55.2%). The patient case presented here is a novel case of pediatric mandibular NUT carcinoma. Due to the poor overall survival of patients with NUT carcinoma, aggressive upfront resection with 2-cm margins followed by adjuvant chemoradiation is advocated.
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Affiliation(s)
- C Jimenez
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - E Stanton
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - K Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - E M Nickels
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - L Jacob
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Shah
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA.
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3
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Fu S, Wang Z, Li C, Li Y, Zhang K, Zhong Z, Zhong Y. The whole treatment process and thinking of a patient with NUT carcinoma of the parotid gland: a case report. Front Oncol 2023; 13:1094770. [PMID: 37205183 PMCID: PMC10185818 DOI: 10.3389/fonc.2023.1094770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Background Primary nuclear protein in testis (NUT) carcinoma is a rare malignant tumor originating from the salivary glands that usually occurs in midline structures, such as the head and neck, and has been identified in young patients. Progression of NUT carcinoma is rapid, and there is a high degree of malignant invasion. The median survival time of NUT carcinoma patients is 6 to 9 months, and 80% of the patients die within 1 year after diagnosis. Case description This case report summarizes the treatment of a 36-year-old male patient with NUT carcinoma of the right parotid gland. The overall survival of the patient was 2 years. We also discuss the applications and outcomes of immune checkpoint inhibitor and targeted therapy combination regimens in the treatment of NUT carcinoma. Conclusion We suggest that targeted therapy combined with immunotherapy which has long-term clinical benefits and targeted therapy which has high clinical response rate(immunotherapy + dual-targeting three-drug regimens) is an ideal choice for the treatment of patients with rare and/or refractory tumors and will not compromise patient safety. Clinical trial registration identifier ChiCTR1900026300.
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Affiliation(s)
- Shujuan Fu
- Oncology Department, Shanghai TCM-Intergrated Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiying Wang
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cunya Li
- Oncology Department, Shanghai TCM-Intergrated Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun Li
- Oncology Department, Shanghai TCM-Intergrated Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zhang
- Oncology Department, Shanghai TCM-Intergrated Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhixian Zhong
- Breast Cancer Center, East Hospital Affiliated to Tongji University, Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Yi Zhong
- Oncology Department, Shanghai TCM-Intergrated Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yi Zhong,
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NUT Carcinoma in Children and Adolescents: The Expert European Standard Clinical Practice Harmonized Recommendations. J Pediatr Hematol Oncol 2022; 45:165-173. [PMID: 36219702 DOI: 10.1097/mph.0000000000002568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Nuclear protein of the testis (NUT) carcinoma (NC) is a rare and highly aggressive tumor mainly occurring in adolescents and young adults, defined by the presence of a somatic NUTM1 rearrangement. The aim is to establish internationally harmonized consensus recommendations for the diagnosis and treatment of adolescents and young adults with NC in the framework of the European Reference Network for Paediatric Oncology. METHODS The European Cooperative Study Group for Pediatric Rare Tumors developed recommendations according to the Consensus Conference Standard Operating procedure methodology and reviewed by external "experts." No evidence of level I to II exists. Recommendations were developed based on published prospective (level III), but more frequently retrospective series (level IV), case reports (level V), and personal expertise (level V). In addition, "strength" of recommendations were categorized by grading (grade A to E). RESULTS Histology is mandatory for the diagnosis of NC, including immunolabeling with anti-NUT antibodies and molecular biology (NUTM1 rearrangement) (level V; grade A). Treatment of NC usually combines aggressive approaches in multimodal regimens. Chemotherapy should be considered as first-line treatment (neoadjuvant vincristine-adriamycin-ifosfamide/cisplatin-adriamycin-ifsofamide or vincristine-doxorubicin-cyclophosphamide/ifosfamide-etoposide) for unresectable or metastatic tumor (ie, 3 courses), rapidly followed by local treatment (level IV; grade B). Referral to a specialized surgical oncology center is highly recommended (level V; grade A). In localized NC, a complete microscopic surgical resection should be attempted whenever and as soon as possible, followed by primary irradiation (60 to 70 Gy) and involved lymph nodes area (level IV; grade B). For head and neck tumors, a systematic neck dissection might be considered, even if N0 (level V; grade C). Adjuvant postirradiation chemotherapy is recommended, for a total of 9 to 12 courses (level IV; grade B). For first-line resected tumors, concomitant adjuvant chemotherapy to radiotherapy may be discussed (level IV; grade B). Targeted therapies and immunotherapeutic regimens should be delivered in the setting of prospective trials (level V; grade B). CONCLUSIONS This project leads to a consensus strategy based on international experience with this very rare disease.
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Lauer UM, Hinterleitner M, Horger M, Ohnesorge PV, Zender L. NUT Carcinoma—An Underdiagnosed Malignancy. Front Oncol 2022; 12:914031. [PMID: 35957893 PMCID: PMC9360329 DOI: 10.3389/fonc.2022.914031] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
NUT carcinoma (NC) is a rare and highly aggressive malignancy with a dismal prognosis and a median survival of 6–9 months only. Although very few cases of NC are reported each year, the true prevalence is estimated to be much higher, with NC potentially widely underdiagnosed due to the lack of awareness. NC primarily occurs in midline structures including thorax, head, and neck; however, other sites such as pancreas and kidney are also affected, albeit at lower frequencies. NC is characterized by a single translocation involving the NUTM1 (NUT midline carcinoma family member 1) gene and different partner genes. The resulting fusion proteins initiate tumorigenesis through a mechanism involving BET (bromo-domain and extra-terminal motif) proteins such as Bromodomain-containing protein 4 (BRD4) and inordinate acetylation of chromatin, leading to the dysregulation of growth and differentiation genes. While no clinical characteristics are specific for NC, some histologic features can be indicative; therefore, patients with these tumor characteristics should be routinely tested for NUTM1. The diagnosis of NC using immunohistochemistry with a highly specific antibody is straightforward. There are currently no standard-of-care treatment options for patients with NC. However, novel therapies specifically addressing the unique tumorigenic mechanism are under investigation, including BET inhibitors. This review aims to raise awareness of this underdiagnosed cancer entity and provide all patients the opportunity to be properly diagnosed and referred to a clinical study.
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Affiliation(s)
- Ulrich M. Lauer
- Medical Oncology and Pneumology, Internal Medicine VIII, University Hospital Tübingen, Tübingen, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
- *Correspondence: Ulrich M. Lauer,
| | - Martina Hinterleitner
- Medical Oncology and Pneumology, Internal Medicine VIII, University Hospital Tübingen, Tübingen, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
| | - Marius Horger
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Tübingen, Germany
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Paul V. Ohnesorge
- Medical Oncology and Pneumology, Internal Medicine VIII, University Hospital Tübingen, Tübingen, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
| | - Lars Zender
- Medical Oncology and Pneumology, Internal Medicine VIII, University Hospital Tübingen, Tübingen, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
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NUT Midline Carcinoma: A Rare Solid Tumour Characterized by Chromosome Rearrangement. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3369895. [PMID: 35832518 PMCID: PMC9273375 DOI: 10.1155/2022/3369895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023]
Abstract
Objective Rare and poorly differentiated NUT midline carcinoma (NMC) is a highly malignant tumour. However, due to the rarity of NMC, reports on its clinical, imaging, and pathologic features are still scarce. Methods In this study, three patients diagnosed with NMC located in the parotid gland, lung, and trachea were used as examples to summarize the clinicopathological features of NMC. All the cases were diagnosed by measuring positive nuclear reactivity to NUT antibody after dual-colour FISH tests were conducted, and all of the results were positive, indicating chromosomal rearrangements on 15q14 of the NUT gene. Results These three patients were treated with conventional treatments, including surgical therapy and chemoradiotherapy. Given the poor efficacy of intensive conventional treatment, two novel therapies, histone deacetylase inhibitors (HDACi) and bromodomain inhibitors (BETi) are recommended, as both can arrest the growth of tumour cells, and these targeted therapies may extend patient survival time in the future. Conclusions NMC is an easily misdiagnosed cancer with a poor prognosis; therefore, improving the awareness of clinicians is critical for increasing the diagnostic accuracy, and selecting effective treatment is the main method to improve prognosis.
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7
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Zhao R, Hua Z, Hu X, Zhang Q, Zhang J, Wang J. NUT Carcinoma of the Lung:A Case report and Literature Analysis. Front Oncol 2022; 12:890338. [PMID: 35903693 PMCID: PMC9321640 DOI: 10.3389/fonc.2022.890338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
NUT carcinoma is a rare, highly aggressive cancer that feature as the rearrangement of the nuclear protein in the testis (NUT) gene on chromosome 15q14, and its pathogenesis and treatment is not yet clear. In this case, we report a 40-year-old male patient who was diagnosed with primary pulmonary NUT carcinoma in The Second Affiliated Hospital of Zhengzhou University. A tumor was found at the right hilus pulmonis when his physical examination with chest pain for half a month. Histopathology confirmed by fluorescence in situ hybridization technique for the NUT carcinoma. After chemotherapy, radiotherapy, immunotherapy, and targeted therapy were given, the patient died. The overall survival time was 4.7 months. Combined with the existing literature, we retrospective report the clinical and pathological characteristics and treatment strategies of the rare lung NUT carcinoma.
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Affiliation(s)
- Rongshuang Zhao
- Department of Oncology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ze Hua
- Department of Oncology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaodong Hu
- Department of Medical Imaging, Zhengzhou University People’s Hospital (Henan Provincial People’s Hospital), Zhengzhou, China
| | - Qi Zhang
- Department of Precision Medicine Center, The Zhengzhou University, Zhengzhou, China
| | - Jin Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Wang
- Department of Oncology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jian Wang,
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8
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Lemelle L, Moya-Plana A, Dumont B, Fresneau B, Laprie A, Claude L, Deneuve S, Cordero C, Pierron G, Couloigner V, Bernard S, Cardoen L, Brisse HJ, Jehanno N, Metayer L, Fréneaux P, Helfre S, Kolb F, Thariat J, Réguerre Y, Orbach D. NUT carcinoma in children, adolescents and young adults. Bull Cancer 2022; 109:491-504. [DOI: 10.1016/j.bulcan.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
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9
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Agaimy A, Haller F, Renner A, Niedermeyer J, Hartmann A, French CA. Misleading Germ Cell Phenotype in Pulmonary NUT Carcinoma Harboring the ZNF532-NUTM1 Fusion. Am J Surg Pathol 2022; 46:281-288. [PMID: 34232599 PMCID: PMC8741879 DOI: 10.1097/pas.0000000000001774] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
NUT carcinoma (aka NUT midline carcinoma) is a rare, still significantly underrecognized aggressive malignancy. Although historically considered a midline malignancy of children and young adults, NUT carcinoma can originate in almost any body site and in any age group. Beside the classic BRD4-NUTM1 fusion, less common fusion partners include BRD3, NSD3, ZNF532, and ZNF592. Other fusions, including CIC, MGA, MXD4, MXD1, and BCORL1 are associated with sarcomas or cancers of unknown histogenesis. Involvement of the Z4 zinc finger protein (ZNF) family members ZNF532 and ZNF592 is exceedingly rare with only 3 recently reported cases. We herein describe a ZNF532-NUTM1-rearranged NUT carcinoma presenting as a 7.5 cm mass in the left lower lung lobe of a 65-year-old woman. Histology revealed undifferentiated monotonous small round cells with focal epithelioid and rhabdoid elements within a variably myxoid stroma. Immunohistochemistry revealed paucity of keratins and variable p63 combined with extensive CD30 and PLAP expression, leading to initial diagnoses of combined small cell carcinoma, CD30-positive unclassified hematolymphoid malignancy and malignant germ cell neoplasm. Negativity for other more specific germ cell markers justified seeking a fourth opinion, which revealed diffuse expression of the NUT antibody. The diagnosis was then confirmed by fluorescence in situ hybridization. Targeted RNA sequencing revealed the ZNF532-NUTM1 fusion. Screening of 7 NUT carcinomas (5 with BRD4-NUTM1 and 2 with NSD3-NUTM1 fusions) for germ cell markers revealed focal SALL4 reactivity in 3 cases (combined with variable AFP expression in 2), but none expressed CD30 or PLAP. An aberrant germ cell immunophenotype should be considered in NUT carcinoma to avoid misinterpretation as genuine germ cell malignancy as both diseases predominantly affect the young population, frequently involve the mediastinum and can be associated with elevated serum AFP.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Florian Haller
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - André Renner
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Jost Niedermeyer
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital, Erlangen, Germany
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Li X, Shi H, Zhang W, Bai C, He M, Ta N, Huang H, Ning Y, Fang C, Qin H, Dong Y. Immunotherapy and Targeting the Tumor Microenvironment: Current Place and New Insights in Primary Pulmonary NUT Carcinoma. Front Oncol 2021; 11:690115. [PMID: 34660264 PMCID: PMC8515126 DOI: 10.3389/fonc.2021.690115] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
Primary pulmonary nuclear protein of testis carcinoma is a rare and highly aggressive malignant tumor. It accounts for approximately 0.22% of primary thoracic tumors and is little known, so it is often misdiagnosed as pulmonary squamous cell carcinoma. No effective treatment has been formed yet, and the prognosis is extremely poor. This review aims to summarize the etiology, pathogenesis, diagnosis, treatment, and prognosis of primary pulmonary nuclear protein of testis carcinoma in order to better recognize it and discuss the current and innovative strategies to overcome it. With the increasing importance of cancer immunotherapy and tumor microenvironment, the review also discusses whether immunotherapy and targeting the tumor microenvironment can improve the prognosis of primary pulmonary nuclear protein of testis carcinoma and possible treatment strategies. We reviewed and summarized the clinicopathological features of all patients with primary pulmonary nuclear protein of testis carcinoma who received immunotherapy, including initial misdiagnosis, disease stage, immunohistochemical markers related to tumor neovascularization, and biomarkers related to immunotherapy, such as PD-L1 (programmed death-ligand 1) and TMB (tumor mutational burden). In the meanwhile, we summarized and analyzed the progression-free survival (PFS) and the overall survival (OS) of patients with primary pulmonary nuclear protein of testis carcinoma treated with PD-1 (programmed cell death protein 1)/PD-L1 inhibitors and explored potential population that may benefit from immunotherapy. To the best of our knowledge, this is the first review on the exploration of the tumor microenvironment and immunotherapy effectiveness in primary pulmonary nuclear protein of testis carcinoma.
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Affiliation(s)
- Xiang Li
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Hui Shi
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Miaoxia He
- Department of Pathology, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Na Ta
- Department of Pathology, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yunye Ning
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Chen Fang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Hao Qin
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yuchao Dong
- Department of Respiratory and Critical Care Medicine, Changhai Hospital (The First Affiliated Hospital of Naval Medical University), Naval Medical University (Second Military Medical University), Shanghai, China
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11
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Juneja M, Solomon B, Hanna GG. Nuclear protein in testis carcinoma: a diagnostic and therapeutic challenge. Intern Med J 2021; 51:1191-1192. [PMID: 34278690 DOI: 10.1111/imj.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Manu Juneja
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin Solomon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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12
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Riess JW, Rahman S, Kian W, Edgerly C, Heilmann AM, Madison R, Ramkissoon SH, Klaitman SS, Chung JH, Trabucco SE, Jin DX, Alexander BM, Klempner SJ, Albacker LA, Frampton GM, Roisman LC, Miller VA, Ross JS, Schrock AB, Gregg JP, Peled N, Sokol ES, Ali SM. Genomic profiling of solid tumors harboring BRD4-NUT and response to immune checkpoint inhibitors. Transl Oncol 2021; 14:101184. [PMID: 34333275 PMCID: PMC8340305 DOI: 10.1016/j.tranon.2021.101184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 12/28/2022] Open
Abstract
NUT carcinoma is a rare but aggressive solid tumor that can be diagnosed by presence of the BRD4-NUT fusion. This series presents 31 cases of solid tumors that harbor BRD4-NUT but often carry other diagnoses such NSCLC—NOS and NSCLC-SCC. Despite lack of PD-L1 expression and a low tumor mutational burden, two index cases responded to either nivolumab or atezolizumab+chemotherapy with partial response or better with 4–5 month duration of response. The unexpected response to checkpoint inhibitors could be explained by a very high affinity of the fusion peptide at the junction of BRD4 and NUT to the MHC complex as recently suggested for an exceptional response to an immune checkpoint inhibitor in a fusion bearing low TMB, low PD-L1 expression head and neck carcinoma.
Background The translocation t(15:19) produces the oncogenic BRD4-NUT fusion which is pathognomonic for NUT carcinoma (NC), which is a rare, but extremely aggressive solid tumor. Comprehensive genomic profiling (CGP) by hybrid-capture based next generation sequencing of 186+ genes of a cohort of advanced cancer cases with a variety of initial diagnoses harboring BRD4-NUT may shed further insight into the biology of these tumors and possible options for targeted treatment. Case presentation Thirty-one solid tumor cases harboring a BRD4-NUT translocation are described, with only 16% initially diagnosed as NC and the remainder carrying other diagnoses, most commonly NSCLC—NOS (22%) and lung squamous cell carcinoma (NSCLC-SCC) (16%). The cohort was all microsatellite stable and harbored a low Tumor Mutational Burden (TMB, mean 1.7 mut/mb, range 0–4). In two index cases, patients treated with immune checkpoint inhibitors (ICPI) had unexpected partial or better responses of varying duration. Notably, four cases – including the two index cases - were negative for PD-L1 expression. Neo-antigen prediction for BRD4-NUT and then affinity modeling of the peptide-MHC (pMHC) complex for an assessable index case predicted very high affinity binding, both on a ranked (99.9%) and absolute (33 nM) basis. Conclusions CGP identifies BRD4-NUT fusions in advanced solid tumors which carry a broad range of initial diagnoses and which should be re-diagnosed as NC per guidelines. A hypothesized mechanism underlying responses to ICPI in the low TMB, PD-L1 negative index cases is the predicted high affinity of the BRD4-NUT fusion peptide to MHC complexes. Further study of pMHC affinity and response to immune checkpoint inhibitors in patients with NC harboring BRD4-NUT is needed to validate this therapeutic hypothesis.
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Affiliation(s)
- Jonathan W Riess
- UC Davis Comprehensive Cancer Center, Sacramento, CA, United States
| | | | - Waleed Kian
- Legacy Heritage Oncology Center/Larry Norton Cancer Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | | | | | | | | | - Shai Shlomi Klaitman
- Legacy Heritage Oncology Center/Larry Norton Cancer Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | - Jon H Chung
- Foundation Medicine, Cambridge, MA, United States
| | | | - Dexter X Jin
- Foundation Medicine, Cambridge, MA, United States
| | | | | | | | | | - Laila C Roisman
- Legacy Heritage Oncology Center/Larry Norton Cancer Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | | | - Jeffrey S Ross
- Foundation Medicine, Cambridge, MA, United States; SUNY Upstate Medical University
| | | | - Jeffrey P Gregg
- UC Davis Comprehensive Cancer Center, Sacramento, CA, United States; Foundation Medicine, Cambridge, MA, United States
| | - Nir Peled
- Legacy Heritage Oncology Center/Larry Norton Cancer Institute, Soroka Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | | | - Siraj M Ali
- Foundation Medicine, Cambridge, MA, United States.
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13
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Testori A, Ferraroli G, De Carlo C, Bossi P, Alloisio M, Mangiameli G. Tracheal polypoid combined small cell lung cancer (C-SCLC): A case report. Thorac Cancer 2021; 12:2035-2038. [PMID: 33990130 PMCID: PMC8258355 DOI: 10.1111/1759-7714.13992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy with a poor prognosis that accounts for 10% of all cases of clinical lung cancer. Due to its high growth fraction and rapid doubling time it is usually diagnosed as extensive local or metastatic disease in 60%–70% of cases. Combined small cell lung cancer (C‐SCLC) is a relatively rare subtype of SCLC and is defined as SCLC combined with any elements of non‐small cell lung cancer (NSCLC). Clinical presentation of SCLC as an isolated pedunculated endotracheal lesion is an especially rare occurrence. Here, we report for the first time the occurrence of a C‐SCLC as a polypoid tumor of the trachea diagnosed in an 80‐year‐old woman admitted to the emergency department with a principal complaint of cough and wheezing.
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Affiliation(s)
- Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Ferraroli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Camilla De Carlo
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Paola Bossi
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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14
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Agaimy A, Tögel L, Stoehr R, Meidenbauer N, Semrau S, Hartmann A, Mantsopoulos K. NSD3-NUTM1-rearranged carcinoma of the median neck/thyroid bed developing after recent thyroidectomy for sclerosing mucoepidermoid carcinoma with eosinophilia: report of an extraordinary case. Virchows Arch 2021; 479:1095-1099. [PMID: 33891143 PMCID: PMC8724182 DOI: 10.1007/s00428-021-03103-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 12/18/2022]
Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is an exceedingly rare low-grade thyroid malignancy of unknown histogenesis. NUT carcinoma is another rare, highly aggressive neoplasm with predilection for the midline, defined by recurrent NUTM1 fusions. The bromodomain family genes (BRD4 or BRD3) and rarely NSD3, ZNF532, or others are known fusion partners. We describe an extraordinary case of a 42-year-old female with a thyroid SMECE treated by thyroidectomy and neck dissection. She presented 6 months later with extensive midline recurrence encasing/compressing the trachea. Biopsy revealed poorly differentiated carcinoma with abrupt squamous differentiation, suggestive of NUT carcinoma. Immunohistochemistry confirmed expression of monoclonal NUT antibody. Targeted RNA sequencing revealed the NSD3-NUTM1 fusion in the NUT carcinoma, but not in the SMECE. This unique case highlights unusual sequential origin of two exceptionally rare entities at same anatomic site and underlines the necessity of sampling unexpectedly aggressive recurrences of otherwise indolent malignancies.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Krankenhausstrasse 8-10, 91054, Erlangen, Germany.
| | - Lars Tögel
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Robert Stoehr
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Norbert Meidenbauer
- Departments of Internal Medicine 5 (Medical Oncology and Hematology), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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15
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Saik WN, Da Forno P, Thway K, Khurram SA. NUT Carcinoma Arising from the Parotid Gland: A Case Report and Review of the Literature. Head Neck Pathol 2020; 15:1064-1068. [PMID: 33351171 PMCID: PMC8384986 DOI: 10.1007/s12105-020-01254-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
NUT carcinoma is an aggressive carcinoma with an overall poor survival outcome. The mediastinum and head and neck area, especially the sinonasal region, are among the common sites of disease. Histopathological diagnosis of NUT carcinoma is often very challenging due to its overlapping features with other poorly differentiated carcinomas. We report a case of NUT carcinoma arising from the parotid gland of a young female patient. Primary NUT carcinoma of salivary gland is very rare, with only 15 such cases reported in the literature to date. Our case highlights the diagnostic challenges associated with such lesions.
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Affiliation(s)
- Wei-Ning Saik
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, 19 Claremont Crescent, Sheffield, S10 2TA UK
| | - Philip Da Forno
- Department of Histopathology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Khin Thway
- Head and Neck Unit; Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Syed Ali Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, 19 Claremont Crescent, Sheffield, S10 2TA UK ,Head and Neck Unit; Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
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16
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Vakani PN, Maheshwari J, Maheshwari M, Shah B. Sinonasal NUT midline carcinoma: A new histological entity. INDIAN J PATHOL MICR 2020; 63:103-105. [PMID: 32031134 DOI: 10.4103/ijpm.ijpm_373_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nuclear protein in testis (NUT) midline carcinoma is poorly differentiated carcinoma defined by rearrangement of NUT gene on 15 to other genes, usually BRD4 on 19. It is first described in 1991. These tumors are most commonly seen in the mediastinum and 35% occur in head and neck. It is a highly aggressive tumor with a median survival of 7 months because of ineffective chemotherapy and undefined treatment. Hence, we must differentiate these tumors from other poorly differentiated tumors. Here, we present a case of NUT midline carcinoma of 44-year male, who presented with headache and dizziness, confirmed by immunohistochemistry of NUT antibody. The aim of this case report is to increase the awareness about this entity in adults with brief review of relevant literature.
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Affiliation(s)
- Pragya N Vakani
- Consultant Pathologist, Nirmaan Pathology Laboratory, Ahmedabad, Gujarat, India
| | - Jainil Maheshwari
- Research Fellow at Nirmaan Pathology Laboratory, Ahmedabad, Gujarat, India
| | - Mukesh Maheshwari
- Consultant Pathologist, Nirmaan Pathology Laboratory, Ahmedabad, Gujarat, India
| | - Bhoomi Shah
- Tutor SMS Medical College, Ahmedabad, Gujarat, India
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17
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McLean-Holden AC, Moore SA, Gagan J, French CA, Sher D, Truelson JM, Bishop JA. NUT Carcinoma in a Patient with Unusually Long Survival and False Negative FISH Results. Head Neck Pathol 2020; 15:698-703. [PMID: 32918711 PMCID: PMC8134642 DOI: 10.1007/s12105-020-01220-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Nuclear protein in testis (NUT) carcinoma is a rare and highly aggressive epithelial malignancy defined by rearrangement of the NUTM1 gene on chromosome 15q14. Histologically, NUT carcinoma is an undifferentiated carcinoma formed by sheets and nests of primitive and monotonous "round blue cells" with foci of abrupt keratinization in a subset. NUT carcinoma runs a fulminant clinical course and is almost always quickly lethal, with a median overall survival of only 6.7 months. There is no consensus regarding treatment for this disease, and most patients respond poorly to conventional chemotherapy and radiation. We report a case of NUT carcinoma in an African-American man who initially presented in 2009 with a tracheal mass at age 28. Although fluorescence in situ hybridization (FISH) assays for NUTM1 and BRD4 rearrangements were negative, he was diagnosed based on diffusely positive NUT immunostaining and BRD4-NUTM1 on RNA sequencing. Since his initial presentation, he has undergone multiple surgical procedures and radiation therapy. His tumor has recurred twice, but he has survived for 129 months and is currently alive without disease. Long-term survival of patients with NUT carcinoma is incredibly unusual, especially in patients with tumors that exhibit a BRD4 rearrangement. False negative FISH is a pitfall in diagnosing NUT carcinoma; NUT immunostaining and RNA sequencing are more sensitive diagnostic methods.
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Affiliation(s)
- Anne C McLean-Holden
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samantha A Moore
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Gagan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher A French
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John M Truelson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- UT Southwestern Medical Center, Clements University Hospital, UH04.250 6201 Harry Hines Blvd, Dallas, TX, 75390, USA.
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18
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Positron Emission Tomography and Molecular Imaging of Head and Neck Malignancies. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00366-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Virarkar M, Saleh M, Ramani NS, Morani AC, Bhosale P. Imaging spectrum of NUT carcinomas. Clin Imaging 2020; 67:198-206. [PMID: 32866821 DOI: 10.1016/j.clinimag.2020.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022]
Abstract
Nuclear protein of the testis (NUT) carcinoma (NC) (formerly known as NUT midline carcinoma) is an aggressive pleomorphic squamous cell carcinoma with a dismal prognosis. Primary NC tumors are commonly located in the chest or head and neck regions. Imaging plays an indispensable role in the staging, management, treatment response assessment, and surveillance of NC. Primary pulmonary NC usually presents as a large mass with lymphadenopathy and pleural involvement. Primary head and neck NC presents as a large expansile necrotic mass in the sinonasal region with locoregional destruction and occasional cervical lymph node involvement. These imaging features are relatively non-specific but are consistent among patients. Currently, there are no standardized guidelines for the treatment of NC. Because of its rarity, paucity of reports in the medical literature, and the lack of awareness among radiologists, NUT carcinoma (NC) has been largely underdiagnosed and misdiagnosed. Clinical aggressive features and pleomorphic/undifferentiated squamous cell carcinoma should prompt genetic evaluation for NUT translocation to diagnose NC. In this article, we discuss NC's clinicopathologic and imaging features and treatment options, including emerging new treatments.
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Affiliation(s)
- Mayur Virarkar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Mohammed Saleh
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Nisha Subhashchandra Ramani
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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20
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Orman G, Masand P, Hicks J, Huisman TAGM, Guillerman RP. Pediatric thoracic mass lesions: Beyond the common. Eur J Radiol Open 2020; 7:100240. [PMID: 32577435 PMCID: PMC7300149 DOI: 10.1016/j.ejro.2020.100240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 01/03/2023] Open
Abstract
Thoracic mass lesions can be categorized as originating in one of the three major compartments: a) chest wall and pleura, b) lung parenchyma and airways, c) mediastinum. While some of these, such as lymphoma, are common in both children and adults, others are rare and unique to childhood. The goal of this review is to familiarize radiologists with unusual but distinctive mass lesions of the pediatric thorax.
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Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
| | - Prakash Masand
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
| | - John Hicks
- Department of Pathology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030 United States
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21
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Wang H, Weiss VL, Hoffman RD, Abel T, Ho RH, Borinstein SC, Mannion K, Bridge JA, Black J, Liang J. Salivary Gland NUT Carcinoma with Prolonged Survival in Children: Case Illustration and Systematic Review of Literature. Head Neck Pathol 2020; 15:236-243. [PMID: 32077054 PMCID: PMC8010040 DOI: 10.1007/s12105-020-01141-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/04/2020] [Indexed: 01/03/2023]
Abstract
NUT (midline) carcinoma is a rare, highly aggressive, poorly differentiated carcinoma that characteristically harbors a rearrangement of the NUTM1 gene. Most of these tumors occur in adolescents and young adults, arise from the midline structures of the thorax, head, and neck, and are associated with extremely poor outcomes. Rare cases originating from salivary glands have been reported with clinicopathologic features comparable to NUT carcinoma of other sites. Outcome studies regarding this subgroup are currently lacking. We report a case of NUT carcinoma arising in a submandibular gland of a 12-year-old boy. Diagnosis was confirmed by fluorescence in situ hybridization demonstrating fusion of the BRD4 (19p13.12) and NUTM1 (15q14) gene loci. A systematic review of all previously reported salivary gland NUT carcinomas (n = 15) showed exclusive occurrence of pediatric cases (n = 6) in males compared to adult patients (n = 9, male: female = 1:2; p < 0.05). The median survival was 24 and 4 months for pediatric and adult patients, respectively (95% confidence interval was 8-24 and 1-7 months, respectively; p < 0.01). The 1-year overall survival was 67% for pediatric and 11% for adult patients. Among all NUT carcinomas, pediatric salivary gland tumors may represent a distinct clinical subset associated with male predilection and comparatively prolonged survival.
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Affiliation(s)
- Huiying Wang
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Vivian L. Weiss
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Robert D. Hoffman
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Ty Abel
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Richard H. Ho
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, USA
| | - Scott C. Borinstein
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, USA
| | - Kyle Mannion
- grid.412807.80000 0004 1936 9916Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, USA
| | - Julia A. Bridge
- grid.266813.80000 0001 0666 4105Division of Molecular Pathology, The Translational Genomics Research Institute (TGen) and the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, USA
| | - Jennifer Black
- grid.413957.d0000 0001 0690 7621Department of Pathology and Laboratory Medicine, Children’s Hospital of Colorado, Aurora, USA
| | - Jiancong Liang
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA ,grid.416074.00000 0004 0433 6783Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital At Vanderbilt, 2200 Children’s Way, 11223 Doctors’ Office Tower, Nashville, TN 37232-9065 USA
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22
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Thompson LD, Lewis JS, Skálová A, Bishop JA. Don't stop the champions of research now: a brief history of head and neck pathology developments. Hum Pathol 2020; 95:1-23. [DOI: 10.1016/j.humpath.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
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23
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NUT midline carcinoma: Current concepts and future perspectives of a novel tumour entity. Crit Rev Oncol Hematol 2019; 144:102826. [DOI: 10.1016/j.critrevonc.2019.102826] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 01/22/2023] Open
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24
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Neves‐Silva R, Almeida LY, Silveira HA, Colturato CBN, Duarte A, Ferrisse TM, Silva EV, Vanzolin BF, Bufalino A, Ribeiro‐Silva A, León JE. SMARCB1 (INI‐1) and NUT immunoexpression in a large series of head and neck carcinomas in a Brazilian reference center. Head Neck 2019; 42:374-384. [DOI: 10.1002/hed.26008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/17/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rodrigo Neves‐Silva
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Luciana Y. Almeida
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Heitor A. Silveira
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Carla B. N. Colturato
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Andressa Duarte
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Tulio M. Ferrisse
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Evânio V. Silva
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Bárbara F. Vanzolin
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Andreia Bufalino
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental SchoolSão Paulo State University (UNESP) Araraquara São Paulo Brazil
| | - Alfredo Ribeiro‐Silva
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
| | - Jorge E. León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP)University of São Paulo Ribeirão Preto São Paulo Brazil
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25
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Lichtenberger JP, Biko DM, Carter BW, Pavio MA, Huppmann AR, Chung EM. Primary Lung Tumors in Children: Radiologic-Pathologic Correlation From the Radiologic Pathology Archives. Radiographics 2019; 38:2151-2172. [PMID: 30422774 DOI: 10.1148/rg.2018180192] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Primary lung tumors in children are rare, with a narrow range of diagnostic considerations. However, the overlapping imaging appearances of these tumors necessitate attention to key discriminating imaging and pathologic features. In the neonate and infant, the important considerations include pleuropulmonary blastoma (PPB), infantile fibrosarcoma, and fetal lung interstitial tumor. Among these tumors, imaging findings such as air-filled cysts in type 1 PPB and homogeneously low attenuation of fetal lung interstitial tumors are relatively specific. Key pathologic and genetic discriminators among this group of tumors include the DICER1 germline mutation found in PPB and the t(12,15)(p13;q25) translocation and ETV6-NTRK3 fusion gene seen in infantile fibrosarcoma. Primary lung tumors in older children include inflammatory myofibroblastic tumors (IMTs), carcinoid salivary gland-type tumors of the lung, recurrent respiratory papillomatosis, and other rare entities. IMT, a spindle-cell proliferation with inflammatory elements, is the most common lung tumor in children. Anaplastic lymphoma kinase, a receptor-type protein tyrosine kinase, is present in 50% of these tumors, and this finding may support an imaging diagnosis of IMT. Carcinoid tumors account for a substantial portion of childhood lung tumors, and their characteristic avid enhancement on images corresponds to the compressed fibrovascular stroma histologically. Furthermore, novel imaging agents used with somatostatin receptor analogs have an emerging role in the evaluation of carcinoid tumors. Although less common than mucoepidermoid carcinoma, adenoid cystic carcinoma tends to recur given the perineural spread seen histologically. Integrating radiologic and pathologic knowledge is critical to accurate diagnosis, treatment planning, and surveillance of primary lung tumors in children.
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Affiliation(s)
- John P Lichtenberger
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - David M Biko
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Brett W Carter
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Michael A Pavio
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Alison R Huppmann
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Ellen M Chung
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
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26
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Oliveira LJC, Gongora ABL, Latancia MT, Barbosa FG, Gregorio JVAM, Testagrossa LA, Amano MT, Feher O. The first report of molecular characterized BRD4-NUT carcinoma in Brazil: a case report. J Med Case Rep 2019; 13:279. [PMID: 31492174 PMCID: PMC6731562 DOI: 10.1186/s13256-019-2213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
Abstract
Background NUT midline carcinoma is a rare and aggressive subset of squamous cell carcinoma, which is characterized by the translocation of nuclear protein in testis gene that is mostly fused with bromodomain and extraterminal family proteins. We describe here the first Brazilian case of NUT midline carcinoma with BRD4-NUT fusion detected in a next-generation sequencing panel and we present the clinical evolution of this patient. Case presentation A 42-year-old Caucasian man was diagnosed with poorly differentiated squamous cell carcinoma of the left maxillary sinus, with negative in situ hybridization for Epstein–Barr encoding region and human papillomavirus genotyping. He received induction therapy, chemoradiotherapy with weekly systemic chemotherapy, and, concurrently, weekly intra-arterial chemotherapy. New imaging evaluation, 1 month after the end of the last treatment, revealed a good partial response in the primary lesion. However, positron emission tomography-computed tomography showed multiple suspicious lesions in his bones and lungs, which were histologically confirmed. He died exactly 2 months after metastatic disease was diagnosed. Conclusions NUT midline carcinoma is usually very aggressive. Currently, there is no standard of care for treatment of NUT midline carcinoma. The definitive diagnosis must be by demonstration of NUTM1 rearrangement. Immunohistochemical staining of greater than 50% of tumor nuclei on formalin-fixed paraffin-embedded tissue using the monoclonal rabbit antibody to NUT (clone C52B1), has a specificity of 100%, and sensitivity of 87% for the diagnosis of NUT midline carcinoma. Our case is the first Brazilian case of NUT midline carcinoma with BRD4-NUT fusion.
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Affiliation(s)
- Leandro J C Oliveira
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91. 2nd floor. Building A, São Paulo, 01308-050, Brazil.
| | - Aline B L Gongora
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91. 2nd floor. Building A, São Paulo, 01308-050, Brazil
| | - Marcela T Latancia
- Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, Brazil
| | - Felipe G Barbosa
- Serviço de Medicina Nuclear, Hospital Sírio Libanês, São Paulo, Brazil
| | - João Vitor A M Gregorio
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91. 2nd floor. Building A, São Paulo, 01308-050, Brazil.,Serviço de Oncologia, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Mariane T Amano
- Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, São Paulo, Brazil
| | - Olavo Feher
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91. 2nd floor. Building A, São Paulo, 01308-050, Brazil.,Serviço de Oncologia, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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27
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Tasche KK, Samuelson MI, Pagedar NA. Unilateral Nasal Mass in a Woman in Her 20s. JAMA Otolaryngol Head Neck Surg 2019; 145:862-863. [PMID: 31294763 DOI: 10.1001/jamaoto.2019.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kendall K Tasche
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City
| | - Megan I Samuelson
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City
| | - Nitin A Pagedar
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City
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28
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NUT Carcinoma of the Salivary Glands: Clinicopathologic and Molecular Analysis of 3 Cases and a Survey of NUT Expression in Salivary Gland Carcinomas. Am J Surg Pathol 2019; 42:877-884. [PMID: 29649019 DOI: 10.1097/pas.0000000000001046] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
NUT carcinoma (NC) represents a rare subset of highly aggressive poorly differentiated carcinomas characterized by rearrangement of the NUT (aka NUTM1, nuclear protein in testis) gene, most commonly fused to BRD4. Originally described as a mediastinal/thymic malignancy, NC has been reported at a variety of anatomic regions including the upper and lower aerodigestive tract. To date, only 7 NC cases of probable salivary gland origin have been reported. We herein describe 3 new cases (all affecting the parotid gland) in 2 women (39- and 55-y old) and 1 man (35-y old). Histologic examination showed poorly differentiated neoplasms composed of poorly cohesive small-sized to medium-sized cells with variable squamoid cell component that was focal and abrupt. Immunohistochemistry showed uniform expression of p63 and distinctive punctate expression of the NUT antigen in the tumor cell nuclei. Review of the reported salivary gland NC cases (total, 10) showed a male:female ratio of 1.5:1 and an age range of 12 to 55 years (median, 29 y). Site of the primary tumor was the parotid (7), sublingual (2), and submandibular (1) glands. All presented as rapidly growing masses treated by surgery followed by adjuvant radiotherapy/chemotherapy. Initial nodal status was positive in 8/10. At last follow-up (1 to 24 mo; median, 5 mo), 7/10 patients died of disease at a median of 5.5 months (1 to 24 mo) and only 2 were disease free at 7 and 14 months. Of 9 cases with genetic data, the fusion partner was BRD4 (n=7), non-BRD4/3 (n=1), or undetermined (n=1). None of 306 carcinomas spanning the spectrum of salivary carcinoma types screened by NUT immunohistochemistry was positive. This is the first small series on salivary NC highlighting the importance to include this rare disease in the differential diagnosis of poorly differentiated salivary gland carcinomas and in cases of presumable poorly differentiated carcinoma of unknown origin.
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29
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Napolitano M, Venturelli M, Molinaro E, Toss A. NUT midline carcinoma of the head and neck: current perspectives. Onco Targets Ther 2019; 12:3235-3244. [PMID: 31118674 PMCID: PMC6501778 DOI: 10.2147/ott.s173056] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract: NUT midline carcinoma (NMC) is a rare and aggressive subtype of squamous carcinoma that typically arises from midline supradiaphragmatic structures, frequently from the head and neck area. NMC is genetically driven by a chromosomal rearrangement involving the NUT gene, which forms oncoproteins considered major pathogenic drivers of cellular transformation. Diagnosis of NMC has been made remarkably easier with the availability of a commercial antibody against NUT, and can be established through positive nuclear immunohistochemical staining. Although NMC remains an underrecognized malignancy, in recent years there has appeared to be increasing awareness of disease and frequency of diagnosis in adults. To date, a standard treatment for head and neck NMC has not been established and a multimodal approach with systemic chemotherapy, surgery and radiation therapy is currently adopted in clinical practice. Recently, BET inhibitors and histone deacetylase inhibitors have emerged as two promising classes of targeted agents, currently investigated in clinical trials for adults with head and neck NMC. At the same time, combination approaches and novel targeted agents, such as next-generation BET inhibitors and CDK9 inhibitors, have shown preclinical activity. The present review explores the clinical pathological characteristics of NMC of the head and neck and presents the current state of the art on diagnosis, prognosis, and treatment of this rare but lethal disease.
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Affiliation(s)
- M Napolitano
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - M Venturelli
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - E Molinaro
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - A Toss
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
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30
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Dean KE, Shatzkes D, Phillips CD. Imaging Review of New and Emerging Sinonasal Tumors and Tumor-Like Entities from the Fourth Edition of the World Health Organization Classification of Head and Neck Tumors. AJNR Am J Neuroradiol 2019; 40:584-590. [PMID: 30765377 DOI: 10.3174/ajnr.a5978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
Abstract
The sinonasal tract is an environment diverse with neoplasia. Given the continued discovery of entities generally specific to the sinonasal tract, the fourth edition of the World Health Organization Classification of Head and Neck Tumors was released in 2017. It describes 3 new, well-defined entities and several less-defined, emerging entities. The new entities are seromucinous hamartomas, nuclear protein in testis carcinomas, and biphenotypic sinonasal sarcomas. Emerging entities include human papillomavirus-related sinonasal carcinomas, SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1-deficient sinonasal carcinomas, renal cell-like adenocarcinomas, and chondromesenchymal hamartomas. The literature thus far largely focuses on the pathology of these entities. Our goal in this report was to familiarize radiologists with these new diagnoses and to provide available information regarding their imaging appearances.
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Affiliation(s)
- K E Dean
- From the Department of Radiology (K.E.D., C.D.P.), NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - D Shatzkes
- Department of Radiology (D.S.), Lenox Hill Hospital, Northwell Health, New York, New York
| | - C D Phillips
- From the Department of Radiology (K.E.D., C.D.P.), NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
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31
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Guilmette J, Sadow PM. High-Grade Sinonasal Carcinoma: Classification Through Molecular Profiling. Arch Pathol Lab Med 2019; 143:1416-1419. [PMID: 30779592 DOI: 10.5858/arpa.2018-0224-rs] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-grade sinonasal carcinomas are a cohort of malignant epithelial neoplasms arising in the sinonasal cavities with distinct, ominous morphologic features or lacking well-differentiated features that might otherwise classify them as less biologically worrisome. Recent advances in molecular profiling have led to the identification of several distinct tumor entities previously grouped together. These molecularly distinct lesions include NUT (midline) carcinoma, INI1 (SMARCB1)-deficient carcinoma, SMARCA4-deficient sinonasal carcinoma, and novel IDH-mutant sinonasal undifferentiated carcinoma, in addition to the previously described lymphoepithelial carcinoma that may also be included in the differential diagnosis. The discovery of these distinct molecular tumor profiles may have significant clinical impact as targeted molecular-based therapeutics continue to evolve, and they may offer some respite for patients who have these highly aggressive cancers.
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Affiliation(s)
- Julie Guilmette
- From the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Peter M Sadow
- From the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston
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32
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Shenoy KD, Stanzione N, Caron JE, Fishbein GA, Abtin F, Lluri G, Hirschowitz SL. Midline carcinoma expressing NUT in malignant effusion cytology. Diagn Cytopathol 2019; 47:594-598. [PMID: 30734527 DOI: 10.1002/dc.24150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 11/05/2022]
Abstract
Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare and aggressive subset of poorly differentiated squamous cell carcinoma that is defined by t(15,19) and typically presents in the midline structures of the head, neck, and mediastinum. We report two cases of NMC that presented uniquely with malignant pleural and pericardial effusions including one with cardiac tamponade at presentation. The first case is of a 25-year-old male patient who presented with progressive dyspnea associated with palpitations and dizziness on standing, found to have large bilateral pleural effusions. The second case is of a previously healthy 29-year-old male patient who presented with progressive dyspnea, cough with expectoration, and a large right lower neck mass of 3 months onset, and a large left pleural effusion and left lung infiltrate on imaging studies. Both cases showed malignant cells on cytology suggestive of poorly differentiated carcinoma. Subsequent histopathological and immunochemistry studies were consistent with the diagnosis of NMC. Both patients had a rapid decline in status and suffered comorbidities secondary to their carcinoma, inevitably leading to their death. It is important to consider NUT midline carcinomas can present in a variety of clinical scenarios, and it is important to consider in the differential diagnoses when evaluating malignant effusion cytology. Utilization of ancillary testing with a broad immunostain profile including NUT studies, as well as fluorescent in-situ hydridization (FISH) studies are helpful and necessary in making the appropriate diagnosis.
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Affiliation(s)
- Krithika Damodar Shenoy
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nicholas Stanzione
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Justin E Caron
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Fereidoun Abtin
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Gentian Lluri
- Department of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sharon L Hirschowitz
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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33
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Albrecht T, Harms A, Roessler S, Goeppert B. NUT carcinoma in a nutshell: A diagnosis to be considered more frequently. Pathol Res Pract 2019; 215:152347. [PMID: 30782401 DOI: 10.1016/j.prp.2019.01.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
NUT carcinoma is a rarely diagnosed, poorly differentiated subtype of squamous cell carcinoma, defined by chromosomal rearrangements of the gene encoding nuclear protein of the testis (NUT). It is characterized by extremely aggressive clinical behavior resulting in a dismal prognosis, with a median survival of 6.7 months. Though most frequently detected along the body midline, NUT carcinoma can arise in any organ. Fewer than 100 cases have been reported in medical literature with the majority of patients being children or young adults. Here we present a case of sinonasal NUT in a 48-year-old male who came to our hospital due to progressive cephalalgia. Radiographically, an irregular mass in the left sphenoidal sinus suspicious for a malignant process was detected, and biopsies were taken. Histopathologically, a tumor of highly mitotic, predominantly small to middle-sized cells with a focal abrupt transition to mature-appearing, squamous epithelium was noted. Of critical importance for the diagnosis, the undifferentiated tumor cell population robustly expressed NUT. The diagnosis of NUT carcinoma was confirmed by the identification of BRD4-NUT fusion. This case integrates typical morphological, immunohistochemical and molecular characteristics of NUT carcinoma and highlights the need to consider this entity in cases of poorly differentiated squamous carcinoma.
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Affiliation(s)
- Thomas Albrecht
- Institute of Pathology, Heidelberg University Hospital, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.
| | - Alexander Harms
- Institute of Pathology, Heidelberg University Hospital, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Stephanie Roessler
- Institute of Pathology, Heidelberg University Hospital, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Benjamin Goeppert
- Institute of Pathology, Heidelberg University Hospital, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
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34
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Reddy R, Woods TR, Allan RW, Malhotra P, Mehta HJ, Sarkar PK, Boyce BJ, Asirvatham JR. NUT (Nuclear Protein in Testis) Carcinoma: A Report of Two Cases With Different Histopathologic Features. Int J Surg Pathol 2018; 27:225-229. [DOI: 10.1177/1066896918796606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
NUT (nuclear protein in testis) carcinoma (NC) is an aggressive carcinoma characterized by rearrangements of the NUT gene on chromosome 15q14. Histologically, it is a poorly differentiated carcinoma composed of monotonous, medium-sized, round cells with scant amphophilic or eosinophilic cytoplasm. Foci of abrupt keratinization are often seen. In this report, we compare the morphology of 2 cases of NC. The first case shows characteristic features of uniform, round epithelioid cells admixed with foci of abrupt keratinization. The second case demonstrates nests of epithelioid-polygonal cells that appear to be loosely cribriform within a mucoid stroma. Although considered rare, the actual incidence of NC may be underestimated, as it is likely that many go undiagnosed because the morphology deviates from what is typical. Our report demonstrates that NC should always be considered in any case of an undifferentiated carcinoma and should not be excluded if typical histologic and immunohistochemical features of squamous differentiation are lacking.
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Affiliation(s)
| | - Tina R. Woods
- University of Mississippi Medical Center, Jackson, MS, USA
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35
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Hellquist H, Hunt JL, Cardesa A, Skalova A, Slootweg PJ, Rinaldo A, Ferlito A. Role of ancillary techniques in profiling unclassified laryngeal malignancies. Virchows Arch 2018; 472:705-715. [PMID: 29623469 DOI: 10.1007/s00428-018-2348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/09/2018] [Accepted: 03/26/2018] [Indexed: 12/31/2022]
Abstract
Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".
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Affiliation(s)
- H Hellquist
- CBMR, Centre for Biomedical Research, University of Algarve, Edificio 2, Ala Norte, University of Algarve, 8005-139, Faro, Portugal. .,Epigenetics and Human Disease Laboratory, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal. .,Algarve Biomedical Centre, Campus Gambelas, University of Algarve, Faro, Portugal.
| | - J L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Cardesa
- Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Skalova
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - P J Slootweg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - A Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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36
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Abstract
Immunohistochemistry is a widely available technique that is less challenging and can provide clinically meaningful results quickly and cost-efficiently in comparison with other techniques. In addition, immunohistochemistry allows for the evaluation of cellular localization of proteins in the context of tumor structure. In an era of precision medicine, pathologists are required to classify lung cancer into specific subtypes and assess biomarkers relevant to molecular-targeted therapies. This review summarizes the hot topics of immunohistochemistry in lung cancer, including (i) adenocarcinoma vs squamous cell carcinoma; (ii) neuroendocrine markers; (iii) ALK, ROS1, and EGFR; (iv) PD-L1 (CD274); (v) lung carcinoma vs malignant mesothelioma; and (vi) NUT carcinoma. Major pitfalls in evaluating immunohistochemical results are also described.
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Affiliation(s)
- Kentaro Inamura
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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37
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Lemelle L, Pierron G, Fréneaux P, Huybrechts S, Spiegel A, Plantaz D, Julieron M, Dumoucel S, Italiano A, Millot F, Le Tourneau C, Leverger G, Chastagner P, Carton M, Orbach D. NUT carcinoma in children and adults: A multicenter retrospective study. Pediatr Blood Cancer 2017. [PMID: 28643357 DOI: 10.1002/pbc.26693] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nuclear protein of the testis (NUT) carcinoma (formerly NUT midline carcinoma) is an aggressive tumor defined by the presence of NUT rearrangement with a poor prognosis. This rare cancer is underdiagnosed and poorly treated. OBJECTIVE The primary objective of this study was to describe the clinical, radiologic, and biological features of NUT carcinoma. The secondary objective was to describe the various treatments and assess their efficacy. METHODS This retrospective multicenter study was based on review of the medical records of children and adults with NUT carcinoma with specific rearrangement or positive anti-NUT nuclear staining (>50%). RESULTS This series of 12 patients had a median age of 18.1 years (ranges: 12.3-49.7 years). The primary tumor was located in the chest in eight patients, the head and neck in three patients, and one patient had a multifocal tumor. Nine patients presented regional lymph node involvement and eight distant metastases. One-half of patients were initially misdiagnosed. Specific NUT antibody was positive in all cases tested. A transient response to chemotherapy was observed in four of 11 patients. Only two patients were treated by surgery and five received radiotherapy with curative intent. At the end of follow-up, only one patient was still in remission more than 12 years after the diagnosis. Median overall survival was 4.7 months (95% confidence interval [CI]: 2.1-17.7). CONCLUSION NUT carcinoma is an aggressive disease refractory to conventional therapy. Early diagnosis by NUT-specific antibody immunostaining in cases of undifferentiated or poorly differentiated carcinoma to identify the specific rearrangement of NUT gene is useful to propose the optimal therapeutic strategy.
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Affiliation(s)
- Lauriane Lemelle
- Department of Pediatric, Adolescent, Young Adults, Institut Curie, Paris, France
| | - Gaëlle Pierron
- Unité de Génétique somatique, Institut Curie, Paris, France
| | - Paul Fréneaux
- Département de pathologie, Institut Curie, Paris, France
| | - Sophie Huybrechts
- Hematology-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, ULB Université libre de Bruxelles, Brussels, Belgium
| | - Alexandra Spiegel
- Department of Pediatric Hematology-Oncology, CHU Hautepierre, Strasbourg, France
| | - Dominique Plantaz
- Department of Pediatric Hematology-Oncology, Hôpital de Grenoble, Grenoble, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | - Sophie Dumoucel
- CHU Sainte Justine, University of Montreal, Montreal, Canada
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Fréderic Millot
- Pediatric Oncology Department, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Christophe Le Tourneau
- Medical Oncology Department, Institut Curie, Paris, France.,INSERM U900 Research unit, Saint-Cloud, France
| | - Guy Leverger
- Department of Pediatric Hematology and Oncology, Assistance Publique - Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France
| | - Pascal Chastagner
- Department of Pediatric Hematology-Oncology, Hôpital d'Enfants de Brabois, Vandoeuvre Les Nancy, France
| | - Matthieu Carton
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric, Adolescent, Young Adults, Institut Curie, Paris, France.,French Pediatric Rare Tumor Group (groupe Fracture)
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Abstract
Advances in lung cancer genomics have revolutionized the diagnosis and treatment of this heterogeneous and clinically significant group of tumors. This article provides a broad overview of the most clinically relevant oncogenic alterations in common and rare lung tumors, with an emphasis on the pathologic correlates of the major oncogenic drivers, including EGFR, KRAS, ALK, and MET. Illustrations emphasize the morphologic diversity of lung adenocarcinoma, including genotype-phenotype correlations of genomic evolution in tumorigenesis. Molecular diagnostic approaches, including PCR-based testing, massively parallel sequencing, fluorescence in situ hybridization, and immunohistochemistry are reviewed.
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Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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39
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Abstract
Squamous cell carcinoma (SCC) is a malignant epithelial tumor showing evidence of squamous differentiation. It is the most common malignancy of the larynx, with several variants (verrucous, exophytic or papillary, spindle-cell, basaloid, acantholytic, adenosquamous) recognized, with well-established precursor lesions. Dysplasia is now separated into only low-grade and high-grade categories. Each SCC variant has unique cytomorphologic features and histologic differential diagnoses that are important to consider, as management and outcomes are different.
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Affiliation(s)
- Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91367, USA.
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40
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Bjornstrup LR, Reibel J, Kiss K, Schioedt M. NUT carcinoma presenting in the palate - a case report. APMIS 2017; 125:933-936. [DOI: 10.1111/apm.12710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023]
Affiliation(s)
| | - Jesper Reibel
- Department of Oral Pathology; University of Copenhagen; Copenhagen Denmark
| | - Katalin Kiss
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
| | - Morten Schioedt
- Department of Oral & Maxillofacial Surgery; Rigshospitalet; Copenhagen Denmark
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41
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D'Ambrosio L, Palesandro E, Moretti M, Pelosi G, Fabbri A, Carnevale Schianca F, Aglietta M, Grignani G. Alpha-fetoprotein elevation in NUT midline carcinoma: a case report. BMC Cancer 2017; 17:266. [PMID: 28407756 PMCID: PMC5390376 DOI: 10.1186/s12885-017-3262-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 04/04/2017] [Indexed: 01/23/2023] Open
Abstract
Background Nuclear protein in testis (NUT) midline carcinoma is a rarely diagnosed and potentially under-recognized type of squamous carcinoma that is considered one of the most aggressive human solid tumors. Alpha-fetoprotein elevation has been associated with chronic liver diseases and a limited number of cancers. In particular, in presence of a mediastinal mass in a young man, alpha-fetoprotein elevation is considered nearly pathognomonic of a non-seminoma germ-cell tumor. Case presentation A 22-year old man without any comorbidity was diagnosed with a large mediastinal mass with skeletal and lymph node metastases. The clinical picture was dominated by a life-threatening superior vena cava syndrome with elevated alpha-fetoprotein and lactate dehydrogenase that supported the diagnostic suspicion of mediastinal germ-cell tumor. However, a biopsy showed a poorly-differentiated and diffusely necrotic carcinoma. We eventually reached the diagnosis of the peculiar entity of NUT midline carcinoma, but the differential diagnosis was quite challenging also because alpha-fetoprotein is not reported as a marker of NUT midline carcinoma. Notably, alpha-fetoprotein levels correlated with disease course. Conclusions The life-threatening aggressiveness of NUT midline carcinoma mandates to reach the right diagnosis in the shortest possible time. In this regard, poorly differentiated carcinomas lacking glandular differentiation mandate testing for NUT expression by immunohistochemistry. Awareness of a potentially misleading tumor marker elevation can help to broaden the differential diagnosis and establish the most appropriate treatment.
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Affiliation(s)
- Lorenzo D'Ambrosio
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino Medical School, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Erica Palesandro
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino Medical School, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Marina Moretti
- Department of Oncohematology, University of Perugia, Santa Maria Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Venezian 1, 20133, Milan, Italy
| | - Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Fabrizio Carnevale Schianca
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino Medical School, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Massimo Aglietta
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy.,Department of Oncology, University of Torino Medical School, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy. .,Department of Oncology, University of Torino Medical School, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy.
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42
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Seim NB, Philips RHW, Schoenfield L, Teknos TN, Rocco JW, Agrawal A, Ozer E, Carrau RL, Kang SY, Old MO. NUT Midline Carcinoma of the Sublingual Gland: Clinical Presentation and Review. Head Neck Pathol 2017; 11:460-468. [PMID: 28349372 PMCID: PMC5677058 DOI: 10.1007/s12105-017-0809-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
NUT midline carcinoma (NMC) is a rare and aggressive disease encountered in the midline of the head and neck or mediastinum. Due to its sparse incidence and subtle pathologic features, we aim to increase knowledge and awareness for this pathologic entity. We present an exemplary case of a young, healthy male presenting with oral cavity pain and cervical lymphadenopathy. This patient was initially diagnosed with an unspecified, highly aggressive sublingual gland malignancy and underwent locoregional resection with free flap reconstruction however suffered a rapid local recurrence and widely extensive metastasis within just 1 month. After rigorous analysis, final pathologic diagnosis revealed a poorly differentiated carcinoma with evidence of squamous differentiation that eventually, post-mortem tested positive for NMC. Only one prior case of sublingual gland NMC has been previously reported as we discuss the literature regarding all sublingual gland malignancies as well as the pathologic features and treatment options for NMC. We recommend consideration of testing for the NUT proto-oncogene at the time of biopsy in the clinical setting of a poorly differentiated midline carcinoma, especially with squamous differentiation, of the head or neck in order to identify patients for clinical trial enrollment and appropriately counsel on the poor clinical prognosis. Improving clinician awareness is critical to increase diagnostic accuracy and need to study prospective treatment outcomes as the first step toward improving management of this difficult disease.
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Affiliation(s)
- Nolan B. Seim
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Ramez H. W. Philips
- 0000 0001 2285 7943grid.261331.4The Ohio State University College of Medicine, 370 W. 9th Ave, Columbus, OH 43210 USA
| | - Lynn Schoenfield
- 0000 0001 1545 0811grid.412332.5Department of Pathology, The Ohio State University Wexner Medical Center, Doan Hall, N337B, 410 West 10th Ave., Columbus, OH 43210 USA
| | - Theodoros N. Teknos
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - James W. Rocco
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Amit Agrawal
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Enver Ozer
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Ricardo L. Carrau
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Stephen Y. Kang
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA
| | - Matthew O. Old
- 0000 0001 1545 0811grid.412332.5Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, 4000 Eye and Ear Institute, 915 Olentangy River Road, Columbus, OH 43212 USA ,0000 0001 2285 7943grid.261331.4Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center, The Ohio State University, Starling Loving Hall, B217, 320 West 10th Ave, Columbus, OH 43210 USA
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43
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Stelow EB, Bishop JA. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2017; 11:3-15. [PMID: 28247233 PMCID: PMC5340732 DOI: 10.1007/s12105-017-0791-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022]
Abstract
The sinonasal tract remains an epicenter of a diverse array of neoplasia. This paper discusses changes to the WHO classification system of tumors involving this area. In particular, seromucinous hamartoma, NUT carcinoma, biphenotypic sinonasal sarcoma, HPV-related carcinoma with adenoid cystic features, SMARCB1-deficient carcinoma, and renal cell-like adenocarcinoma are discussed.
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Affiliation(s)
- Edward B. Stelow
- Department of Pathology, Anatomic Pathology, University of Virginia Health System, Jefferson Park Ave., Box 800214, Charlottesville, VA 22908 USA
| | - Justin A. Bishop
- Department of Pathology, Johns Hopkins University, Baltimore, MD USA
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44
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Hellquist H, French CA, Bishop JA, Coca-Pelaz A, Propst EJ, Paiva Correia A, Ngan BY, Grant R, Cipriani NA, Vokes D, Henrique R, Pardal F, Vizcaino JR, Rinaldo A, Ferlito A. NUT midline carcinoma of the larynx: an international series and review of the literature. Histopathology 2017; 70:861-868. [PMID: 27926786 DOI: 10.1111/his.13143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/02/2016] [Indexed: 12/21/2022]
Abstract
AIMS NUT midline carcinoma (NMC) is a rare undifferentiated and aggressive carcinoma that locates characteristically to the midline of the head and neck, and mediastinum. NMC is characterized by chromosomal rearrangements of the gene NUT, at 15q14. The BRD4 gene on 19q13 is the most common translocation partner forming a fusion oncogene, BRD4-NUT. By the end of 2014, the International NUT Midline Carcinoma Registry had 48 patients treated for NMC. Laryngeal NMC are exceedingly rare, and we report a case series of seven cases. METHODS AND RESULTS We searched for cases in files of different hospitals as well as a thorough search of the English language literature. The diagnosis of NMC is made by demonstration of NUT rearrangement either by immunohistochemistry, fluorescence in-situ hybridization (FISH) or reverse transcription-polymerase chain reaction (RT-PCR). We found three previously published cases, and in this series add four cases of our own. CONCLUSIONS NMC consists of monomorphic, often discohesive, cells with an epithelioid appearance and distinct nucleoli. The tumours typically show abrupt squamous differentiation. The mean age of the patients was 34 years, hence significantly lower than that for conventional laryngeal carcinoma. All tumours were located in the supraglottis and five patients died of the disease after 3, 7, 8, 9 and 11 months. Laryngeal NMC may be underdiagnosed, and an increased awareness among pathologists is warranted. NMC has characteristic morphological features, and positive immunostaining with the NUT antibody is diagnostic. Its aggressive behaviour demands a very intense treatment strategy and the need for its recognition is emphasized further by new promising treatment strategies.
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Affiliation(s)
- Henrik Hellquist
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | | | - Justin A Bishop
- Departments of Pathology and Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Bo-Yee Ngan
- Division of Pathology, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ronald Grant
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - David Vokes
- Department of Otolaryngology - Head and Neck Surgery, Auckland City Hospital and Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Rui Henrique
- Department of Pathology, Portuguese Institute of Oncology, Porto, Portugal
| | - Fernando Pardal
- Anatomic Pathology Department, Braga Hospital, Braga, Portugal
| | - Jose Ramon Vizcaino
- Anatomic Pathology Department, St Antonio General Hospital, Porto Hospitals Centre, Porto, Portugal
| | | | - Alfio Ferlito
- University of Udine School of Medicine, Udine, Italy
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45
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Thompson LD. Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach. Mod Pathol 2017; 30:S1-S26. [PMID: 28060373 DOI: 10.1038/modpathol.2016.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/15/2016] [Indexed: 01/02/2023]
Abstract
One of the most challenging diagnostic categories within tumors of the sinonasal tract is the small round blue cell tumors. Biopsies are usually small and limited, resulting in considerable diagnostic difficulty for practicing surgical pathologists. These tumors share several overlapping histologic and immunophenotypic findings while also showing considerable variation within and between cases. Specific tumor site of origin, imaging findings, and clinical findings must be combined with the histology and pertinent ancillary studies if the correct diagnosis is to be reached. Discrimination between neoplasms is critical as there are significant differences in therapy and overall outcome. It is important to have a well developed differential diagnosis for this category of tumors, where each of the diagnoses is considered, evaluated, and either confirmed or excluded from further consideration. In an undifferentiated tumor, showing a small round blue cell morphology, using the mnemonic 'MR SLEEP' helps to highlight tumors to consider: melanoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma (including NUT carcinoma), small cell osteosarcoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), Ewing sarcoma/primitive neuroectodermal tumor, pituitary adenoma, and plasmacytoma. A panel of pertinent immunohistochemistry studies, histochemistries and/or molecular tests should aid in reaching a diagnosis, especially when taking the pattern and intensity of reactions into consideration.
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Affiliation(s)
- Lester Dr Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA, USA
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46
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Sun K, Atoyan R, Borek MA, Dellarocca S, Samson MES, Ma AW, Xu GX, Patterson T, Tuck DP, Viner JL, Fattaey A, Wang J. Dual HDAC and PI3K Inhibitor CUDC-907 Downregulates MYC and Suppresses Growth of MYC-dependent Cancers. Mol Cancer Ther 2016; 16:285-299. [PMID: 27980108 DOI: 10.1158/1535-7163.mct-16-0390] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/26/2016] [Accepted: 11/12/2016] [Indexed: 11/16/2022]
Abstract
Upregulation of MYC is a common driver event in human cancers, and some tumors depend on MYC to maintain transcriptional programs that promote cell growth and proliferation. Preclinical studies have suggested that individually targeting upstream regulators of MYC, such as histone deacetylases (HDAC) and phosphoinositide 3-kinases (PI3K), can reduce MYC protein levels and suppress the growth of MYC-driven cancers. Synergy between HDAC and PI3K inhibition in inducing cancer cell death has also been reported, but the involvement of MYC regulation is unclear. In this study, we demonstrated that HDAC and PI3K inhibition synergistically downregulates MYC protein levels and induces apoptosis in "double-hit" (DH) diffuse large B-cell lymphoma (DLBCL) cells. Furthermore, CUDC-907, a small-molecule dual-acting inhibitor of both class I and II HDACs and class I PI3Ks, effectively suppresses the growth and survival of MYC-altered or MYC-dependent cancer cells, such as DH DLBCL and BRD-NUT fusion-positive NUT midline carcinoma (NMC) cells, and MYC protein downregulation is an early event induced by CUDC-907 treatment. Consistently, the antitumor activity of CUDC-907 against multiple MYC-driven cancer types was also demonstrated in animal models, including DLBCL and NMC xenograft models, Myc transgenic tumor syngeneic models, and MYC-amplified solid tumor patient-derived xenograft (PDX) models. Our findings suggest that dual function HDAC and PI3K inhibitor CUDC-907 is an effective agent targeting MYC and thus may be developed as potential therapy for MYC-dependent cancers. Mol Cancer Ther; 16(2); 285-99. ©2016 AACR.
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Affiliation(s)
| | | | | | | | | | - Anna W Ma
- Curis, Inc., Lexington, Massachusetts
| | | | | | | | | | | | - Jing Wang
- Curis, Inc., Lexington, Massachusetts.
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47
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Harada Y, Koyama T, Takeuchi K, Shoji K, Hoshi K, Oyama Y. NUT midline carcinoma mimicking a germ cell tumor: a case report. BMC Cancer 2016; 16:895. [PMID: 27855672 PMCID: PMC5114840 DOI: 10.1186/s12885-016-2944-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background NUT midline carcinoma (NMC) is a rare and highly aggressive malignancy. Although more information on NMC has been recently accumulating in the literature, most oncologists and pathologists remain unfamiliar with the clinical and pathologic features of this disease. The clinical features of NMC sometimes mimic those of other malignancies, and NMC can therefore be overlooked if the diagnosis is not suspected. We present the case of a young male with NMC arising in the mediastinum with elevated serum alpha-fetoprotein levels suggestive of an extragonadal nonseminomatous germ-cell tumor. Case presentation A 28-year-old Japanese male presented with cough and left-sided chest pain for 6 weeks. The patient had a mediastinal tumor with metastases to the right lung, lymph nodes, and bones at initial presentation. Nonseminomatous germ cell tumor was suspected due to the young age, location of the tumors, and elevated serum alpha-fetoprotein. However, biopsy confirmed the diagnosis of NMC with immunohistochemistry. The tumor briefly responded to cytotoxic chemotherapy but subsequently progressed and became refractory to the chemotherapy regimen. External beam radiotherapy was administered with dramatic shrinkage of the tumor and a metabolic response on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan. However, the patient died 4.5 months after the diagnosis of NMC. Conclusions Serum levels of alpha-fetoprotein may be elevated in patients with NMC. Regardless of the level of tumor markers, immunohistochemistry for NUT should be performed in cases of poorly differentiated carcinomas without glandular differentiation arising in the midline structures. 18F-FDG PET/CT is useful for staging and assessing responses to therapy.
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Affiliation(s)
- Yohei Harada
- Department of Medical Oncology, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan. .,Department of Internal Medicine, Division of Haematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University, Saga, Japan.
| | - Takafumi Koyama
- Department of Medical Oncology, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan
| | - Kengo Takeuchi
- Pathology Project for Molecular Targets, the Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.,Division of Pathology, the Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazufusa Shoji
- Department of Radiation Therapy, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan
| | - Kazuei Hoshi
- Department of Diagnostic Pathology, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan
| | - Yu Oyama
- Department of Medical Oncology, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan
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48
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Abstract
Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare, aggressive, poorly differentiated form of squamous cell carcinoma caused by a chromosomal rearrangement of the NUT gene on chromosome 15. These tumors have a predilection for midline and paramidline structures of the upper aerodigestive tract and mediastinum and can affect patients across a broad age range, including children. In the current example, a 53 year old male presented with a mass originating in the left nasal cavity. The clinical, radiographic, and morphologic features of NMC are discussed.
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49
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Shatavi S, Fawole A, Haberichter K, Jaiyesimi I, French C. Nuclear protein in testis (NUT) midline carcinoma with a novel three-way translocation (4;15;19)(q13;q14;p13.1). Pathology 2016; 48:620-3. [PMID: 27590195 DOI: 10.1016/j.pathol.2016.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
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50
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Bishop JA, French CA, Ali SZ. Cytopathologic features of NUT midline carcinoma: A series of 26 specimens from 13 patients. Cancer Cytopathol 2016; 124:901-908. [PMID: 27400194 DOI: 10.1002/cncy.21761] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND NUT midline carcinoma (NMC) is an increasingly recognized neoplasm defined by rearrangements of the nuclear protein in testis (NUT) gene (also known as NUTM1). NMC is important to diagnose for prognostic and diagnostic reasons, but to date, only a small case series and rare case reports of the cytopathologic features of NMC have been published. METHODS All NMC specimens (confirmed by molecular testing and/or NUT immunoreactivity) with cytopathologic material available were identified at 2 academic centers. All smears were reviewed, and the cytologic characteristics were described. RESULTS Twenty-six cytopathologic specimens of NMC were identified from 13 patients: 8 men and 5 women ranging in age from 16 to 68 years (mean, 35 years). The NMCs arose in the mediastinum (n = 4), sinonasal tract (n = 4), neck (n = 2), lung (n = 1), lung and mediastinum (n = 1), and kidney (n = 1). Cytologic specimens included serous cavity effusions (n = 13), fine-needle aspirates (n = 9), bronchial brushings (n = 2), bronchial lavage (n = 1), and bronchial washings (n = 1). Ancillary studies were performed on cell blocks for only 6 samples from 4 patients: immunohistochemistry (n = 6) and flow cytometry (n = 1). All 13 NMCs had corresponding surgical pathology material. The NUT rearrangement status was known in 10 cases, and in 3 cases, the diagnosis was established by immunoreactivity for NUT. On cytologic smears, the NMCs were mostly hypercellular with monotonous, small to midsize, primitive-appearing cells largely distributed singly in a discohesive pattern. The tumor cells had round to oval nuclei that appeared mostly naked and devoid of cytoplasm. The nuclei varied in chromatin density from mostly pale, open chromatin to a hyperchromatic, neuroendocrine-type appearance, often with focal cell-to-cell molding, and most examples had a distinct, small nucleolus. CONCLUSIONS NMC is a recently recognized tumor that should be considered in the differential diagnosis of small round cell tumors, especially but not exclusively in the mediastinum and the head and neck. The cytologic features of NMC overlap considerably with those of other neoplasms, and a definitive diagnosis depends on a demonstration of NUT translocation by either immunohistochemical or molecular means. Cancer Cytopathol 2016;124:901-908. © 2016 American Cancer Society.
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Affiliation(s)
- Justin A Bishop
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Syed Z Ali
- Department of Pathology and Radiology, Johns Hopkins Hospital, Baltimore, Maryland
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