1
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Yen H, Chou JL, Li YF, Wang DS. Elucidating the Diagnostic Complexity of Round Cell Sarcoma with EWSR1-CREM Fusion: A Comprehensive Case Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:544. [PMID: 38674190 PMCID: PMC11051956 DOI: 10.3390/medicina60040544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Sarcomas, particularly undifferentiated small round cell sarcomas of bone and soft tissue, pose significant diagnostic challenges due to their nonspecific morphology and the necessity for comprehensive molecular analyses. This paper discusses a rare case of round cell sarcoma exhibiting the EWSR1-CREM fusion, offering insights into the complexities of its diagnosis and management. The patient, a 15-year-old female with a history of Type 1 diabetes, presented with persistent right thigh tenderness and swelling. MRI revealed a large necrotic mass in the retroperitoneal region. Histological analysis showed a well-demarcated tumor with diverse cellular morphologies and distinct necrotic areas. Immunohistochemical (IHC) tests identified dot-like staining for Desmin and Vimentin but negative results for several markers, including Cytokeratin and CD45. Strong ALK positivity was noted. Next-generation sequencing with the Illumina TruSight™ Oncology 500 assay revealed the fusion gene EWSR1-CREM, along with benign and uncertain mutations in other genes. The tumor's morphology and immunoprofile, along with molecular findings, led to a diagnosis of round cell sarcoma with EWSR1-CREM fusion. This case adds to the spectrum of tumors associated with this fusion, often presenting diverse morphologies. The rarity of EWSR1-CREM fusion sarcomas poses a challenge in treatment, highlighted by the development of pulmonary metastases and disease progression after surgical excision in this patient despite the lack of an effective targeted therapy. In conclusion, this case emphasizes the need for a multidisciplinary diagnostic approach in complex sarcomas and highlights the importance of continued research on rare sarcomas, their genetic underpinnings, and potential therapeutic targets.
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Affiliation(s)
- Hao Yen
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Jian-Liang Chou
- Instrument Center, Department of Research and Development, National Defense Medical Center, Taipei 114, Taiwan;
| | - Yao-Feng Li
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Der-Shiun Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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2
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Shen GA, Li YZ, Ren G, Wang MC, Zhou JB, Man Y, Lu WP, Sun PT, Zhang XX. Intracranial mesenchymal tumor with multiple extracranial metastases: A case report and literature review. Radiol Case Rep 2024; 19:825-830. [PMID: 38111550 PMCID: PMC10726333 DOI: 10.1016/j.radcr.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023] Open
Abstract
This study presents a rare case of an older woman with an intracranial mesenchymal tumor in the right frontal and parietal lobes. Despite prompt surgical intervention, her condition rapidly deteriorated because of tumor dissemination, leading to her demise. We highlight the tumor's marked invasiveness and heterogeneity, coupled with a propensity for distant systemic metastasis, which negatively impacted the patient's prognosis. This particular clinical behavior had not been previously reported, making this a novel observation. Thus, through a comprehensive review of relevant literature, we aim to provide valuable insights for further understanding, diagnosing, and treating such tumors.
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Affiliation(s)
- Guo-An Shen
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Yan-Zhao Li
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Gang Ren
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Mu-Chun Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Jing-Bin Zhou
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Yi Man
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Wei-Peng Lu
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Pi-Tong Sun
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Xu-Xin Zhang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
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3
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Mezzacappa FM, Smith FK, Zhang W, Gard A, Cabuk FK, Gonzalez-Gomez I, Monforte HL, Liang J, Singh O, Quezado MM, Aldape KD, Gokden M, Bridge JA, Chen J. Potential prognostic determinants for FET::CREB fusion-positive intracranial mesenchymal tumor. Acta Neuropathol Commun 2024; 12:17. [PMID: 38291529 PMCID: PMC10826246 DOI: 10.1186/s40478-024-01721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/24/2023] [Indexed: 02/01/2024] Open
Abstract
Intracranial mesenchymal tumor (IMT), FET::CREB fusion-positive is a provisional tumor type in the 2021 WHO classification of central nervous system tumors with limited information available. Herein, we describe five new IMT cases from four females and one male with three harboring an EWSR1::CREM fusion and two featuring an EWSR1::ATF1 fusion. Uniform manifold approximation and projection of DNA methylation array data placed two cases to the methylation class "IMT, subclass B", one to "meningioma-benign" and one to "meningioma-intermediate". A literature review identified 74 cases of IMTs (current five cases included) with a median age of 23 years (range 4-79 years) and a slight female predominance (female/male ratio = 1.55). Among the confirmed fusions, 25 (33.8%) featured an EWSR1::ATF1 fusion, 24 (32.4%) EWSR1::CREB1, 23 (31.1%) EWSR1::CREM, one (1.4%) FUS::CREM, and one (1.4%) EWSR1::CREB3L3. Among 66 patients with follow-up information available (median: 17 months; range: 1-158 months), 26 (39.4%) experienced progression/recurrences (median 10.5 months; range 0-120 months). Ultimately, three patients died of disease, all of whom underwent a subtotal resection for an EWSR1::ATF1 fusion-positive tumor. Outcome analysis revealed subtotal resection as an independent factor associated with a significantly shorter progression free survival (PFS; median: 12 months) compared with gross total resection (median: 60 months; p < 0.001). A younger age (< 14 years) was associated with a shorter PFS (median: 9 months) compared with an older age (median: 49 months; p < 0.05). Infratentorial location was associated with a shorter overall survival compared with supratentorial (p < 0.05). In addition, the EWSR1::ATF1 fusion appeared to be associated with a shorter overall survival compared with the other fusions (p < 0.05). In conclusion, IMT is a locally aggressive tumor with a high recurrence rate. Potential risk factors include subtotal resection, younger age, infratentorial location, and possibly EWSR1::ATF1 fusion. Larger case series are needed to better define prognostic determinants in these tumors.
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Affiliation(s)
- Frank M Mezzacappa
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Frankie K Smith
- Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Pathology, University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Weiwei Zhang
- Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Andrew Gard
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Neurological Surgery, MD West ONE, Omaha, NE, USA
| | - Fatmagul Kusku Cabuk
- Department of Pathology, Basaksehir Cam and Sakura City Hospital, Başakşehir, Turkey
| | | | - Hector L Monforte
- Division of Pathology, Johns Hopkins All Children's Hospital, Petersburg, FL, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Omkar Singh
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martha M Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth D Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Murat Gokden
- Department of Pathology, University of Arkansas Medical Center, Little Rock, AR, USA
| | - Julia A Bridge
- Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Molecular Pathology, ProPath, Dallas, TX, USA
| | - Jie Chen
- Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE, 68198, USA.
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4
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Tauziède-Espariat A, Hasty L, Métais A, Varlet P. Mesenchymal non-meningothelial tumors of the central nervous system: a literature review and diagnostic update of novelties and emerging entities. Acta Neuropathol Commun 2023; 11:22. [PMID: 36737790 PMCID: PMC9896826 DOI: 10.1186/s40478-023-01522-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
The fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (CNS) now includes mesenchymal tumors that occur uniquely or frequently in the CNS. Moreover, this version has aligned the terminology of mesenchymal tumors with their soft tissue counterparts. New tumor types have been added, such as the "intracranial mesenchymal tumor, FET-CREB fusion-positive", the "CIC-rearranged sarcoma", and the "Primary intracranial sarcoma, DICER1-mutant". Other entities (such as rhabdomyosarcoma) have remained in the current WHO classification because these tumor types may present specificities in the CNS as compared to their soft tissue counterparts. Based on an extensive literature review, herein, we will discuss these newly recognized entities in terms of clinical observation, radiology, histopathology, genetics and outcome, and consider strategies for an accurate diagnosis. In light of this literature analysis, we will also introduce some potentially novel tumor types.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France. .,Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.
| | - Lauren Hasty
- grid.414435.30000 0001 2200 9055Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France ,grid.512035.0Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alice Métais
- grid.414435.30000 0001 2200 9055Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France ,grid.512035.0Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- grid.414435.30000 0001 2200 9055Department of Neuropathology, Sainte-Anne Hospital, 1, rue Cabanis, 75014 Paris, France ,grid.512035.0Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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5
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Javaid S, Patton A, Tinoco G, Oghumu S, Iwenofu OH. Metastatic sporadic paraganglioma with EWSR1::CREM gene fusion: A unique molecular profile that expands the phenotypic diversity of the molecular landscape of the EWSR1::CREM gene fusion positive tumors. Genes Chromosomes Cancer 2023; 62:85-92. [PMID: 36083250 PMCID: PMC10092737 DOI: 10.1002/gcc.23094] [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: 03/21/2022] [Revised: 08/14/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022] Open
Abstract
Chromosomal translocations with gene fusions are uniquely rare events in paraganglioma, mostly involving UBTF::MAML3 gene fusion. Precedent literature suggests that tumors involving MAML3 gene fusion correlate with poor clinical outcomes. Herein, we report a case of metastatic sporadic paraganglioma harboring EWSR1::CREM gene fusion in a 36-year-old male, that has not been previously described. The patient presented with large paraspinal mass that was resected the same year. Tumor recurred 3-years later and on further work-up, patient was found to have metastases involving both lungs. Histopathologic evaluation of the original primary tumor showed tightly packed irregular nests and cords of cells containing palely eosinophilic cytoplasm. Features considered atypical included: areas of solid growth pattern, coagulative tumor necrosis, focal cellular atypia and angiolymphatic invasion were also identified. By immunohistochemistry, the tumor cells were positive for synaptophysin and chromogranin and negative for keratin. The S100 stain highlights the sustentacular cells and the Ki-67 proliferation index of 15%. The recurrence specimen was similar but showed increased cellularity, atypia, necrosis, and proliferative activity (Ki-67 proliferation index of 35%). CT guided biopsy of the right lung lesion was consistent with metastasis. Next generation sequencing identified EWSR1::CREM fusion. The breakpoints were found in chromosome 22: 29683123 for EWSR1 exon 7 (NM_005243.3) and at chromosome 10:35495823 for CREM exon 6 (NM_001267562.1). Fluorescence in situ hybridization for EWSR1 gene rearrangement was positive. In summary, we report a case of metastatic paraganglioma with EWSR1::CREM gene fusion, not previously described in this entity, and expands on the phenotypic diversity within the genetic landscape of EWSR1::CREM gene fusion positive tumors.
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Affiliation(s)
- Sehrish Javaid
- Division of Oral and Maxillofacial Pathology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Ashley Patton
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gabriel Tinoco
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Medical Center, Columbus, Ohio, USA.,The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Steve Oghumu
- Division of Oral and Maxillofacial Pathology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA.,The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Obiajulu Hans Iwenofu
- Division of Oral and Maxillofacial Pathology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA.,The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
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6
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Tauziède-Espariat A, Pierron G, Guillemot D, Benevello C, Pallud J, Benzakoun J, Hasty L, Métais A, Chrétien F, Varlet P. An extracranial CNS presentation of the emerging "intracranial" mesenchymal tumor, FET: CREB-fusion positive. Brain Tumor Pathol 2023; 40:35-39. [PMID: 36107277 DOI: 10.1007/s10014-022-00443-4] [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: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023]
Abstract
A novel histomolecular tumor, the "intracranial mesenchymal tumor (IMT), FET::CREB fusion-positive", has recently been identified and added to the 2021 World Health Organization Classification of Tumors of the Central Nervous System. One of the essential diagnostic criteria defined in this classification is the intracranial location of the tumor. Herein, we report a spinal case of IMT with a classical EWSR1::CREM fusion. We compare its clinical, histopathological, immunophenotypical, genetic and epigenetic features with those previously described in IMT, FET::CREB fusion-positive. The current case presented histopathological (epithelioid morphology with mucin-rich stroma, and expression of EMA and desmin), radiological (an extraparenchymal lobulated mass without dural tail), genetic (fusion implicating the EWSR1 and CREM genes), and epigenetic (DNA-methylation profiling) similarities to previously reported cases. This case constitutes the third "extracranial" observation of an IMT. Our results added data suggesting that the terminology "IMT, FET::CREB fusion-positive" is provisional and that further series of cases are needed to better characterize them.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, GHU Paris-Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France. .,UMR S1266, INSERM, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France. .,Université de Paris, Paris, France.
| | - Gaëlle Pierron
- INSERMU830, Curie Institute Research Center, Paris-Sciences-Lettres, Paris, France.,Laboratory of Somatic Genetics, Curie Institute Hospital, Paris, France
| | - Delphine Guillemot
- INSERMU830, Curie Institute Research Center, Paris-Sciences-Lettres, Paris, France
| | - Chiara Benevello
- Department of Neurosurgery, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Johan Pallud
- UMR S1266, INSERM, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France.,Université de Paris, Paris, France.,Department of Neurosurgery, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Joseph Benzakoun
- UMR S1266, INSERM, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France.,Department of Radiology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Lauren Hasty
- Department of Neuropathology, GHU Paris-Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France
| | - Alice Métais
- Department of Neuropathology, GHU Paris-Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France.,UMR S1266, INSERM, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France.,Université de Paris, Paris, France
| | - Fabrice Chrétien
- Department of Neuropathology, GHU Paris-Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France.,Université de Paris, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris-Psychiatry and Neuroscience, Sainte-Anne Hospital, 1, rue Cabanis, 75014, Paris, France.,UMR S1266, INSERM, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France.,Université de Paris, Paris, France
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7
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SASAKI M, HIRONO S, GAO Y, SUDA I, MATSUTANI T, OTA M, KISHIMOTO T, IKEDA JI, YOKOO H, IWADATE Y. Clinicopathological and Genomic Features of Pediatric Intracranial Myxoid Mesenchymal Tumor with both of <i>EWSR1-CREM</i> Gene Fusion and<i> MAP3K13</i> Mutation: A Case Report and Comparison with Adult Cases in the Literature. NMC Case Rep J 2022; 9:101-109. [PMID: 35693189 PMCID: PMC9177164 DOI: 10.2176/jns-nmc.2021-0385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/17/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Minami SASAKI
- Department of Neurological Surgery, Chiba University Graduate School of Medicine
| | - Seiichiro HIRONO
- Department of Neurological Surgery, Chiba University Graduate School of Medicine
| | - Yue GAO
- Department of Neurological Surgery, Chiba University Graduate School of Medicine
| | - Izumi SUDA
- Department of Neurological Surgery, Chiba University Graduate School of Medicine
| | - Tomoo MATSUTANI
- Department of Neurological Surgery, Chiba University Graduate School of Medicine
| | - Masayuki OTA
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine
| | - Takashi KISHIMOTO
- Department of Molecular Pathology, Chiba University Graduate School of Medicine
| | - Jun-Ichiro IKEDA
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine
| | - Hideaki YOKOO
- Department of Human Pathology, Gunma University Graduate School of Medicine
| | - Yasuo IWADATE
- Department of Neurological Surgery, Chiba University Graduate School of Medicine
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8
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Levy AS, Sakellakis A, Luther E, Morell AA, Rosenberg A, Saad AG, Ivan M, Komotar RJ. Concurrent intraventricular intracranial myxoid mesenchymal tumor and ependymoma in a long-term Ewing sarcoma survivor. Neuropathology 2022; 42:534-539. [PMID: 35734886 DOI: 10.1111/neup.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 12/15/2022]
Abstract
Intracranial myxoid mesenchymal tumor, FET::CREB fusion positive is a rare, recently described central nervous system neoplasm. It is characterized by EWSR1::CREB family transcription factor fusion, typically arises in children and adolescents, and is locally aggressive even after gross total resection. Currently, there are little data available to guide management and gauge long-term prognosis. Furthermore, there have been no reports of these lesions occurring simultaneously with other intracranial neoplasms or in patients with a history of malignancy. Here we describe the first case of a very unusual patient with intracranial myxoid mesenchymal tumor of the right lateral ventricle with a concurrent fourth ventricular ependymoma who had a remote history of Ewing sarcoma of the right fibula.
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Affiliation(s)
- Adam S Levy
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ana Sakellakis
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis A Morell
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew Rosenberg
- Department of Pathology, University of Miami Health System, Miami, Florida, USA
| | - Ali G Saad
- Department of Pathology, University of Miami Health System, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
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9
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Hojo K, Furuta T, Komaki S, Yoshikane Y, Kikuchi J, Nakamura H, Ide M, Shima S, Hiyoshi Y, Araki J, Tanaka S, Ozono S, Yoshida A, Nobusawa S, Morioka M, Nishikomori R. Systemic inflammation caused by an intracranial mesenchymal tumor with a
EWSR1
::
CREM
fusion presenting associated with
IL
‐6/
STAT3
signaling. Neuropathology 2022. [DOI: 10.1111/neup.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Keishiro Hojo
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Takuya Furuta
- Department of Pathology Kurume University School of Medicine Kurume Japan
| | - Satoru Komaki
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Yukako Yoshikane
- Department of Pediatrics Fukuoka University Chikushi Hospital Chikushino Japan
| | - Jin Kikuchi
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Hideo Nakamura
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Mizuki Ide
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Saho Shima
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Yusuke Hiyoshi
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Junichiro Araki
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Seiji Tanaka
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Shuichi Ozono
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Akihiko Yoshida
- Rare Cancer Center National Cancer Center Hospital Tokyo Japan
- Department of Diagnostic Pathology National Cancer Center Hospital Tokyo Japan
| | - Sumihito Nobusawa
- Department of Human Pathology Gunma University Graduate School of Medicine Maebashi Japan
| | - Motohiro Morioka
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Ryuta Nishikomori
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
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10
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Myoepithelial and oral intracranial myxoid mesenchymal tumor-like neoplasms as diagnostic considerations of the ever-expanding extracranial myxocollagenous tumors harboring FET-CREB fusions. Pathol Res Pract 2022; 229:153700. [DOI: 10.1016/j.prp.2021.153700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
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11
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Cabral de Carvalho Corrêa D, Tesser-Gamba F, Dias Oliveira I, Saba da Silva N, Capellano AM, de Seixas Alves MT, Dastoli PA, Cavalheiro S, Caminada de Toledo SR. Gliomas in children and adolescents: investigation of molecular alterations with a potential prognostic and therapeutic impact. J Cancer Res Clin Oncol 2021; 148:107-119. [PMID: 34626238 DOI: 10.1007/s00432-021-03813-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Gliomas represent the most frequent central nervous system (CNS) tumors in children and adolescents. However, therapeutic strategies for these patients, based on tumor molecular profile, are still limited compared to the wide range of treatment options for the adult population. We investigated molecular alterations, with a potential prognostic marker and therapeutic target in gliomas of childhood and adolescence using the next-generation sequencing (NGS) strategy. METHODS We selected 95 samples with initial diagnosis of glioma from patients treated at Pediatric Oncology Institute-GRAACC/UNIFESP. All samples were categorized according to the 2021 World Health Organization Classification of Tumors of the CNS, which included 39 low-grade gliomas (LGGs) and 56 high-grade gliomas (HGGs). Four HGG samples were classified as congenital glioblastoma (cGBM). NGS was performed to identify somatic genetic variants in tumor samples using the Oncomine Childhood Cancer Research Assay® (OCCRA®) panel, from Thermo Fisher Scientific®. RESULTS Genetic variants were identified in 76 of 95 (80%) tumors. In HGGs, the most common molecular alteration detected was H3F3A c.83A > T variant (H3.3 K27M) and co-occurring mutations in ATRX, TP53, PDGFRA, MET, and MYC genes were also frequently observed. One HGG sample was reclassified as supratentorial ependymoma ZFTA-fusion positive after NGS was performed. In LGGs, four KIAA1549-BRAF fusion transcripts were detected and this alteration was the most recurrent genetic event and favorable prognostic factor identified. Additionally, genetic variants in ALK and NTRK genes, which provide potential targets for therapy with Food and Drug Administration-approved drugs, were identified in two different cases of cGBM that were classified as infant-type hemispheric glioma, a newly recognized subgroup of pediatric HGG. CONCLUSION Molecular profiling by the OCCRA® panel comprehensively addressed the most relevant genetic variants in gliomas of childhood and adolescence, as these tumors have specific patterns of molecular alterations, outcomes, and effectiveness to therapies.
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Affiliation(s)
- Débora Cabral de Carvalho Corrêa
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.,Division of Genetics, Department of Morphology and Genetics, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Francine Tesser-Gamba
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Indhira Dias Oliveira
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Nasjla Saba da Silva
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Andrea Maria Capellano
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil
| | - Maria Teresa de Seixas Alves
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.,Department of Pathology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Patrícia Alessandra Dastoli
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.,Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Sergio Cavalheiro
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.,Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Silvia Regina Caminada de Toledo
- Department of Pediatrics, Pediatric Oncology Institute-GRAACC/UNIFESP, Federal University of Sao Paulo, 743 Botucatu Street, 8th Floor - Genetics Laboratory, Vila Clementino, Sao Paulo, SP, 04023-062, Brazil. .,Division of Genetics, Department of Morphology and Genetics, Federal University of Sao Paulo, Sao Paulo, SP, Brazil.
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Kambe A, Kuwamoto S, Shimizu T, Amisaki H, Sakamoto M, Inagaki H, Kurosaki M. A case of intracranial myxoid mesenchymal tumor with EWSR1:CREM fusion in an adult female: Extensive immunohistochemical evaluation. Neuropathology 2021; 41:315-323. [PMID: 34258808 DOI: 10.1111/neup.12740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/24/2021] [Accepted: 03/31/2021] [Indexed: 01/03/2023]
Abstract
Intracranial myxoid mesenchymal tumor (IMMT) is a recently described, extremely rare group of neoplasms characterized by fusions between the female-expressed transcript (FET) family genes and the cAMP response element-binding protein (CREB) family genes. Controversy persists regarding whether the tumor is a myxoid variant of angiomatoid fibrous histiocytoma or a completely distinct clinicopathological entity. Here, we report a case of IMMT arising in the posterior fossa in a 65-year-old woman with a history of breast cancer. We performed total removal of the tumor, which histologically demonstrated features characteristic of IMMT but also bore a partial resemblance to conventional angiomatoid fibrous histiocytoma. Immunohistochemically, tumor cells were diffusely positive for desmin, vimentin, cluster of differentiation (CD) 99 (CD99), glucose transporter-1, and cytokeratin (CK) 8/18 (CK8/18), and focally positive for CK7, epithelial membrane antigen, mucin 4, anaplastic lymphoma kinase, calponin, and CD68. Molecular genetic analysis revealed a fusion between the Ewing sarcoma breakpoint region 1 (EWSR1) gene (EWSR1) and the cAMP-responsive element modulator (CREM) gene (CREM) called EWSR1:CREM fusion, which confirmed the diagnosis. The overlap of the pathological features of IMMTs and angiomatoid fibrous histiocytomas may support the recent theory that these tumors are two manifestations of a single entity. Moreover, our study indicated the broad spectrum of immunohistochemical phenotypes of these tumors, which should be noted during diagnosis. Further studies are needed to elucidate the histopathological concept, long-term prognosis, optimal treatment strategy, and factors associated with the prognosis and therapeutic options of this condition.
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Affiliation(s)
- Atsushi Kambe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Satoshi Kuwamoto
- Department of Pathology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Tsuyoshi Shimizu
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hidefumi Amisaki
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Makoto Sakamoto
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hirotaka Inagaki
- Department of Neurosurgery, Japanese Red Cross Tottori Hospital, Tottori, Japan
| | - Masamichi Kurosaki
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
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Flucke U, van Noesel MM, Siozopoulou V, Creytens D, Tops BBJ, van Gorp JM, Hiemcke-Jiwa LS. EWSR1-The Most Common Rearranged Gene in Soft Tissue Lesions, Which Also Occurs in Different Bone Lesions: An Updated Review. Diagnostics (Basel) 2021; 11:diagnostics11061093. [PMID: 34203801 PMCID: PMC8232650 DOI: 10.3390/diagnostics11061093] [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: 04/18/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/09/2023] Open
Abstract
EWSR1 belongs to the FET family of RNA-binding proteins including also Fused in Sarcoma (FUS), and TATA-box binding protein Associated Factor 15 (TAF15). As consequence of the multifunctional role of EWSR1 leading to a high frequency of transcription of the chromosomal region where the gene is located, EWSR1 is exposed to aberrations such as rearrangements. Consecutive binding to other genes leads to chimeric proteins inducing oncogenesis. The other TET family members are homologous. With the advent of widely used modern molecular techniques during the last decades, it has become obvious that EWSR1 is involved in the development of diverse benign and malignant tumors with mesenchymal, neuroectodermal, and epithelial/myoepithelial features. As oncogenic transformation mediated by EWSR1-fusion proteins leads to such diverse tumor types, there must be a selection on the multipotent stem cell level. In this review, we will focus on the wide variety of soft tissue and bone entities, including benign and malignant lesions, harboring EWSR1 rearrangement. Fusion gene analysis is the diagnostic gold standard in most of these tumors. We present clinicopathologic, immunohistochemical, and molecular features and discuss differential diagnoses.
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Correspondence: ; Tel.: +31-24-36-14387; Fax: +31-24-36-68750
| | - Max M. van Noesel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Division Cancer & Imaging, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium;
| | - Bastiaan B. J. Tops
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
| | - Joost M. van Gorp
- Department of Pathology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Laura S. Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
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