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Kerper AL, Larsen BT, Folpe AL, Roden AC, Torres-Mora J, Lo YC, Aubry MC, Boland JM. Primary Pulmonary Myxoid Sarcoma and Thoracic Angiomatoid Fibrous Histiocytoma: Two Sides of the Same Coin? Am J Surg Pathol 2024; 48:562-569. [PMID: 38407279 DOI: 10.1097/pas.0000000000002189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Primary pulmonary myxoid sarcoma (PPMS) and thoracic angiomatoid fibrous histiocytoma (AFH) are rare neoplasms with EWSR1 fusions and overlapping morphology. Both tumor types often show epithelial membrane antigen expression, but AFH characteristically co-expresses desmin. We encountered a case of PPMS with the unexpected finding of patchy, strong anaplastic lymphoma kinase (ALK) (previously reported in AFH) and synaptophysin expression. We evaluated a cohort of PPMS and thoracic AFH with systematic morphologic comparison and surveyed for aberrant expression of ALK and synaptophysin. Medical records and slides were reviewed for 16 molecularly confirmed cases of PPMS (n=5) and thoracic AFH (n=11). Each case was scored for morphologic characteristics typical of PPMS and/or AFH. ALK, synaptophysin, chromogranin, desmin, and epithelial membrane antigen immunostains were performed on cases with available tissue. AFH and PPMS cases showed similar age at presentation and long-term tumor behavior. Almost all cases of PPMS and AFH had a fibrous pseudocapsule and lymphoid rim. All PPMS had myxoid stroma and reticular growth pattern, but these features were also present in a subset of AFH. Synaptophysin expression was present in 6 of 11 AFH and 1 of 5 PPMS; all tested cases were negative for chromogranin (n=15). One case of AFH and 1 case of PPMS showed focally strong coexpression of synaptophysin and ALK. AFH and PPMS show considerable clinicopathologic overlap. When supportive, the immunohistochemical findings described may aid in diagnosis before molecular confirmation. PPMS and AFH may be morphologic variants of the same clinicopathologic entity, which can show more immunophenotypic variability than previously reported.
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Affiliation(s)
- Allison L Kerper
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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2
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Dashti NK, Schukow CP, Kilpatrick SE. Back to the future! Selected bone and soft tissue neoplasms with shared genetic alterations but differing morphological and immunohistochemical phenotypes. Hum Pathol 2024; 147:129-138. [PMID: 38521373 DOI: 10.1016/j.humpath.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Bone and soft tissue tumors (BST) are a highly heterogeneous group largely classified by their line of differentiation, based on their resemblance to their normal counterpart in adult tissue. Yet, rendering a specific diagnosis can be challenging, primarily due to their rarity and overlapping histopathologic features or clinical presentations. Over the past few decades, seemingly histogenetic-specific gene fusions/translocations and amplifications have been discovered, aiding in a more nuanced classification, leading to well-established objective diagnostic criteria and the development of specific surrogate ancillary tests targeting these genetic aberrations (e.g., immunohistochemistry). Ironically, the same research also has revealed that some specific tumor subtypes may be the result of differing and often multiple gene fusions/translocations, but, more interestingly, identical gene fusions may be present in more than one phenotypically and biologically distinct neoplasm, sometimes with entirely different clinical behavior. Prime examples include, EWSR1::ATF1 and, less commonly, EWSR1::CREB1 gene fusions present in both clear cell sarcoma, a malignant high-grade tumor with melanocytic differentiation, and angiomatoid fibrous histiocytoma, a mesenchymal neoplasm of intermediate malignancy with a generally indolent course. Similarly, MDM2 amplification, once deemed to be pathognomonic for atypical lipomatous tumor/well differentiated and dedifferentiated liposarcoma, has been documented in a range of additional distinct tumors, including low grade osteosarcomas (e.g. low grade central and surface parosteal) and high-grade intimal sarcomas, amongst others. Such findings reinforce the importance of careful attention to morphological and clinicoradiological features and correlation with molecular testing before rendering a specific diagnosis. Future classification systems in BST neoplasms cannot be solely based on molecular events and ideally will balance morphologic features with molecular analysis. Herein, we provide a narrative literature review of the more common BST neoplasms with shared genetic events but differing demographics, morphology, immunophenotype, and clinical behavior, re-emphasizing the importance of the hematoxylin and eosin slide and the "eye" of the practicing pathologist.
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Affiliation(s)
- Nooshin K Dashti
- Department of Pathology and Laboratory Medicine Dartmouth Health, Lebanon, 03766, NH, USA; Geisel School of Medicine at Dartmouth, Lebanon, 03766, NH, USA
| | - Casey P Schukow
- Corewell Health's Beaumont Hospital, Department of Pathology, Royal Oak, MI, 48073, USA
| | - Scott E Kilpatrick
- Department of Pathology & Laboratory Medicine, Cleveland Clinic, L25, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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3
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Xu ZG, Wang CQ, Lu SP, Huang BF. A case of primary pulmonary myxoid sarcoma with EWSR1-CREB1 fusion. Asian J Surg 2024:S1015-9584(24)00623-7. [PMID: 38604870 DOI: 10.1016/j.asjsur.2024.03.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Zheng-Guo Xu
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China.
| | - Chao-Qun Wang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Shi-Ping Lu
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Bi-Fei Huang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
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4
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Miao X, Chen J, Yang L, Lu H. Primary pulmonary myxoid sarcoma with EWSR1::CREB1 fusion: a literature review. J Cancer Res Clin Oncol 2024; 150:108. [PMID: 38421462 PMCID: PMC10904531 DOI: 10.1007/s00432-024-05634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This review primarily aims to review the epidemiology, clinical characteristics, imaging, pathology, immunohistochemistry, diagnosis, differential diagnosis, treatment, and prognosis of Primary pulmonary myxoid sarcoma (PPMS) with EWS RNA binding protein 1::cAMP response element binding protein 1 (EWSR1::CREB1) fusion. It provides reference for the diagnosis and treatment of this disease. METHODS Retrospectively collected the literature about PPMS with EWSR1::CREB1 fusion, its clinical, radiology, histology, molecular characteristics and current treatment strategies were collated and analyzed. This review provides a detailed differential diagnosis of the disease. RESULTS PPMS is an exceptionally rare, low-grade malignant tumor of the lung. This tumor commonly infiltrates lung tissue and develops within bronchial passages. It is identified by a genetic rearrangement involving the EWSR1 gene and a distinct chromosomal translocation t(2; 22)(q33; q12). Variants include EWSR1::CREB1 fusion and EWS RNA binding protein 1::activating transcription factors (EWSR1::ATF1) fusion. PPMS with EWSR1::CREB1 fusion is more prevalent among middle-aged individuals and affects both sexes almost equally. Clinical symptoms are relatively non-specific, primarily including cough, hemoptysis, and weight loss. Most patients undergo surgery and experience a favorable prognosis. Further research is required to validate the effectiveness of alternative treatments for PPMS with EWSR1::CREB1 fusion. CONCLUSION EWSR1 rearrangement and EWSR1::CREB1 fusion are crucial genetic features of PPMS and serve as important diagnostic markers. Immunohistochemically, PPMS tests positive for EMA. In terms of treatment, surgery has been the primary approach in recent years. Therefore, the efficacy of other treatments still requires further investigation.
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Affiliation(s)
- Xinyu Miao
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Jing Chen
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, People's Republic of China
| | - Lan Yang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, People's Republic of China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology On Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.
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5
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Raskin GA, Mukchina MS, Kaurtseva AS, Ponkina ON, Agurina NV. [Primary pulmonary myxoid sarcoma with EWSR1-CREB1 fusion]. Arkh Patol 2024; 86:37-41. [PMID: 38591905 DOI: 10.17116/patol20248602137] [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] [Indexed: 04/10/2024]
Abstract
Primary pulmonary myxoid sarcoma with EWSR1-CREB1 fusion is an extremely rare tumor. Its clinical manifestation is unspecific and only molecular genetic method can proof this diagnosis. This paper describes an unusual clinical presentation of primary pulmonary myxoid sarcoma in a 68-year-old patient with involvement of both lungs.
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Affiliation(s)
- G A Raskin
- Dr. Sergey Berezin Medical Institute, St. Petersburg, Russia
- Saint-Petersburg State University, St. Petersburg, Russia
| | - M S Mukchina
- Dr. Sergey Berezin Medical Institute, St. Petersburg, Russia
| | - A S Kaurtseva
- Dr. Sergey Berezin Medical Institute, St. Petersburg, Russia
| | - O N Ponkina
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital N1, Krasnodar, Russia
| | - N V Agurina
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital N1, Krasnodar, Russia
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6
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Nishimura T, Ii T, Inamori O, Konishi E, Yoshida A. Primary Pulmonary Myxoid Sarcoma with EWSR1::ATF1 Fusion: A Case Report. Int J Surg Pathol 2023; 31:88-91. [PMID: 35466725 DOI: 10.1177/10668969221095457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary pulmonary myxoid sarcoma is a rare lung sarcoma, mostly involving the central lung and harboring the EWSR1::CREB1 fusion. We report an exceptional case of primary pulmonary myxoid sarcoma arising in the peripheral lung and harboring an EWSR1::ATF1 gene fusion. A 67-year-old man presented with a solid nodule in the right lower lobe, and wedge resection was performed. Microscopically, the tumor consisted of reticular proliferation of uniform mildly atypical spindle cells within abundant myxoid stroma. Immunohistochemically, smooth muscle actin was positive but desmin was negative. Fluorescence in situ hybridization confirmed EWSR1 and ATF1 gene rearrangements. No recurrence was seen for 12 months. Pathological findings and gene rearrangements are important for the diagnosis of primary pulmonary myxoid sarcoma. Complete resection and careful observation are required.
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Affiliation(s)
- Tomoki Nishimura
- Division of Thoracic Surgery, 89662Ayabe City Hospital, Kyoto, Japan
| | - Tsunehiro Ii
- Division of Thoracic Surgery, 89662Ayabe City Hospital, Kyoto, Japan
| | - Osamu Inamori
- Division of Diagnostic Pathology, 89662Ayabe City Hospital, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Graduate School of Medical Science, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, 13874National Cancer Center, Tokyo, Japan
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7
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CT findings of a large primary pulmonary myxoid sarcoma: A case report. Radiol Case Rep 2022; 17:3331-3335. [PMID: 35855858 PMCID: PMC9287777 DOI: 10.1016/j.radcr.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Primary pulmonary myxoid sarcoma (PPMS) is an extremely rare malignant mesenchymal tumor of the lung, with only less than 40 cases reported. We described a case of a 64-years-old man with a mass on the medial and lower lobe of the right lung confirmed as a primary pulmonary myxoid sarcoma on biopsy. Diagnosis of this tumor remains challenging because of its nonspecific clinical and imaging characteristics. This study emphasizes CT finding to improve the understanding of PPMS.
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8
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Extrabronchial Primary Pulmonary Myxoid Sarcoma. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Primary Pulmonary Myxoid Sarcoma and Myxoid Angiomatoid Fibrous Histiocytoma: A Unifying Continuum With Shared and Distinct Features. Am J Surg Pathol 2020; 44:1535-1540. [PMID: 32773530 DOI: 10.1097/pas.0000000000001548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primary pulmonary myxoid sarcoma (PPMS) is a recently reported, exceedingly rare low-grade lung neoplasm characterized by reticular/lace-like growth of spindle to epithelioid cells embedded in an abundant myxoid matrix. Morphologically, it overlaps with a myxoid variant of angiomatoid fibrous histiocytoma (AFH) of the soft tissue. Genetically, they were both reported to harbor EWSR1-CREB1 fusion, while EWSR1-ATF1 has only been reported in AFH thus far. We report a case of primary pulmonary low-grade myxoid spindle cell tumor with morphologic and immunohistochemical features of PPMS but with an EWSR1-ATF1 fusion gene. In addition, we also encountered a case of endobronchial AFH with EWSR1-CREB1 translocation but also focal morphologic features of PPMS. These findings provide new evidence supporting the concept that PPMS and a myxoid variant of AFH represent a continuum with overlapping histologic, immunohistochemical, and genetic features.
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10
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Chen Z, Yang Y, Chen R, Ng CS, Shi H. Primary pulmonary myxoid sarcoma with EWSR1-CREB1 fusion: a case report and review of the literature. Diagn Pathol 2020; 15:15. [PMID: 32039736 PMCID: PMC7008573 DOI: 10.1186/s13000-020-00930-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary pulmonary myxoid sarcoma (PPMS) is an extremely rare lung sarcoma that is characterized in most cases by recurrent balanced chromosomal translocation t(2;22)(q33;q12) leading to the oncogenic fusion gene EWSR1-CREB1. CASE PRESENTATION We report a case of PPMS with molecular confirmation using fluorescence in situ hybridization (FISH) and DNA sequencing in a 45-year-old female patient. Computer tomography (CT) scanning revealed a peripheral circumscribed solid mass of 2.1 × 2 cm in the right lung superior lobe. Histologically, the tumor cells ranged from stellate, polygonal to chondrocyte-like or physaliferous-like, forming reticular network of delicate lace-like cellular strands and cords in abundant myxoid stroma. The tumor cell immunophenotype was positive for vimentin, EMA and negative for CK-pan, TTF-1, CAM5.2, S-100, calponin, SMA, desmin, ALK, CD31 and CD34. Molecular analysis demonstrated EWSR1-CREB1 gene fusion in this tumor. During 38 months of follow-up, the patient was alive with no clinical or radiological evidence of recurrence or metastasis. CONCLUSION PPMS is a rare low-grade sarcoma with distinct histological and genetic features. We add another case to the literature of this rare tumor and report for the first time occurrence of chondrocyte-like and physaliferous-like tumor cells in this tumor, thus enriching its morphologic and cytologic spectrum.
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Affiliation(s)
- Zhenwei Chen
- Department of Pathology, Jinhua Municipal Central Hospital, 351 Mingyue Road, Jinhua, 321000 Zhejiang Province People’s Republic of China
| | - Yihui Yang
- Department of Pathology, Jinhua Municipal Central Hospital, 351 Mingyue Road, Jinhua, 321000 Zhejiang Province People’s Republic of China
| | - Rongming Chen
- Department of Pathology, the People’s Hospital of Changfeng County, Changfeng County, Anhui Province People’s Republic of China
| | - Chi Sing Ng
- Department of Pathology, St. Teresa’s Hospital, Kowloon, Hong Kong
| | - Hongqi Shi
- Department of Pathology, Jinhua Municipal Central Hospital, 351 Mingyue Road, Jinhua, 321000 Zhejiang Province People’s Republic of China
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11
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Koelsche C, Tavernar L, Neumann O, Heußel CP, Eberhardt R, Winter H, Stenzinger A, Mechtersheimer G. Primary pulmonary myxoid sarcoma with an unusual gene fusion between exon 7 of EWSR1 and exon 5 of CREB1. Virchows Arch 2019; 476:787-791. [PMID: 31776646 DOI: 10.1007/s00428-019-02716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/26/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023]
Abstract
Primary pulmonary mesenchymal tumors are rare, yet they compromise a variety of entities. A novel low-grade malignant neoplasm coined primary pulmonary myxoid sarcoma (PPMS) has been introduced in the WHO classification of lung tumors. Molecular analysis in PPMS revealed recurrent gene fusions between EWSR1 and CREB1, a member of the cAMP response element binding protein (CREB) family. However, only 23 PPMS have been reported in the literature reflecting their exceedingly low incidence. Here, we describe the case of a 41-year-old female patient with a lung tumor obstructing the right main bronchus. Histologically, the tumor was composed of spindle-shaped and epithelioid cells exhibiting a reticular growth pattern within a prominent myxoid matrix. Solid areas were also observed. Molecular analysis by next-generation sequencing identified a fusion transcript with an unusual gene fusion involving exon 7 of EWSR1 and exon 5 of CREB1. Together, the diagnosis PPMS was established.
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Affiliation(s)
- Christian Koelsche
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
| | - Luca Tavernar
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Olaf Neumann
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Claus Peter Heußel
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Diagnostic and Interventional of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Ralf Eberhardt
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Pneumology and Critical Care Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Hauke Winter
- Department of Surgery, Thoraxklinik at University Hospital Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Gunhild Mechtersheimer
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
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12
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Endobronchial Myxoma: An Uncommon Entity. J Bronchology Interv Pulmonol 2018; 25:335-339. [PMID: 30048419 DOI: 10.1097/lbr.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 31-year-old woman presented with progressive breathlessness since 1 year. Flexible bronchoscopy revealed a vascular tumor completely occluding the right main bronchus. A diagnosis of primary endobronchial myxoma was made. Tumor debulking was performed using rigid bronchoscopy. This enabled right lower lobectomy. A literature search yielded 12 cases of primary pulmonary myxoma, and only 2 previous reports of endobronchial myxoma. Most tumors were incidentally detected and were cured surgically. Endobronchial myxomas are rare and are usually asymptomatic. Treatment involves surgical excision. Rigid bronchoscopy serves as a bridge to surgery and can reduce the extent of surgery.
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13
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Yanagida R, Balzer BL, Mckenna RJ, Fuller CB. Primary pulmonary myxoid sarcoma, a potential mimic of metastatic extraskeletal myxoid chondrosarcoma. Pathology 2017; 49:792-794. [DOI: 10.1016/j.pathol.2017.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 11/25/2022]
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14
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Kim S, Song SY, Yun JS, Choi YD, Na KJ. Primary pulmonary myxoid sarcoma located in interlobar fissure without parenchymal invasion. Thorac Cancer 2017; 8:535-538. [PMID: 28722216 PMCID: PMC5582455 DOI: 10.1111/1759-7714.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022] Open
Abstract
Primary pulmonary myxoid sarcoma (PPMS), classified as low to intermediate grade malignant myxoid endobronchial tumor, is rarely reported. Most reported cases occurred in lung parenchyme with an endobronchial component. Herein, we report a case of PPMS in a 29‐year‐old woman that developed in a major fissure of the left lung without parenchymal invasion. Histopathologically, the diagnosis was compatible to PPMS with EWSR1‐CREB1 translocation.
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Affiliation(s)
- Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Jeollanam-do, South Korea
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15
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Prieto-Granada CN, Ganim RB, Zhang L, Antonescu C, Mueller J. Primary Pulmonary Myxoid Sarcoma: A Newly Described Entity-Report of a Case and Review of the Literature. Int J Surg Pathol 2017; 25:518-525. [PMID: 28449608 DOI: 10.1177/1066896917706413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary pulmonary myxoid sarcoma (PPMS) is a recently described, exceedingly rare low-grade lung sarcoma that tends to present in young females as an endobronchial mass and shows evidence of an EWSR1- CREB1 fusion. Herein, we present a case of PPMS with fluorescence in situ hybridization (FISH) analysis for EWSR1 and CREB1 rearrangements. An 80-year-old woman presented with an endobronchial, multinodular tumor exhibiting spindle, ovoid and epithelioid cells arranged in reticular/lattice-like and alveolar-like patterns in a myxoid background. The tumor showed focal epithelial membrane antigen immunoreactivity as well as an Alcian blue-positive stroma that was sensitive to digestion with hyaluronidase. EWSR1 and CREB1 rearrangements were detected by break-apart FISH probes. The patient showed persistence of disease 36 months after diagnosis and was discharged to hospice care. We contribute with a report of an additional case of this very unusual entity and perform a brief review of the literature published so far on the subject.
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Affiliation(s)
| | - Rose B Ganim
- 2 Baystate Medical Center-University of Massachusetts Medical School Regional Campus, Springfield, MA, USA
| | - Lei Zhang
- 3 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - James Mueller
- 2 Baystate Medical Center-University of Massachusetts Medical School Regional Campus, Springfield, MA, USA
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16
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The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2016; 10:1243-1260. [PMID: 26291008 DOI: 10.1097/jto.0000000000000630] [Citation(s) in RCA: 2755] [Impact Index Per Article: 344.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 2015 World Health Organization (WHO) Classification of Tumors of the Lung, Pleura, Thymus and Heart has just been published with numerous important changes from the 2004 WHO classification. The most significant changes in this edition involve (1) use of immunohistochemistry throughout the classification, (2) a new emphasis on genetic studies, in particular, integration of molecular testing to help personalize treatment strategies for advanced lung cancer patients, (3) a new classification for small biopsies and cytology similar to that proposed in the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (4) a completely different approach to lung adenocarcinoma as proposed by the 2011 Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, (5) restricting the diagnosis of large cell carcinoma only to resected tumors that lack any clear morphologic or immunohistochemical differentiation with reclassification of the remaining former large cell carcinoma subtypes into different categories, (6) reclassifying squamous cell carcinomas into keratinizing, nonkeratinizing, and basaloid subtypes with the nonkeratinizing tumors requiring immunohistochemistry proof of squamous differentiation, (7) grouping of neuroendocrine tumors together in one category, (8) adding NUT carcinoma, (9) changing the term sclerosing hemangioma to sclerosing pneumocytoma, (10) changing the name hamartoma to "pulmonary hamartoma," (11) creating a group of PEComatous tumors that include (a) lymphangioleiomyomatosis, (b) PEComa, benign (with clear cell tumor as a variant) and
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Thway K, Jordan S, Fisher C, Nicholson AG. Updates in the approach to intrathoracic sarcomas. Histopathology 2015; 67:755-70. [DOI: 10.1111/his.12771] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit; Royal Marsden Hospital; London UK
| | - Simon Jordan
- Department of Surgery; Royal Brompton Hospital; London UK
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Thway K, Fisher C. Angiomatoid fibrous histiocytoma: the current status of pathology and genetics. Arch Pathol Lab Med 2015; 139:674-82. [PMID: 25927151 DOI: 10.5858/arpa.2014-0234-ra] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue neoplasm of intermediate biologic potential and uncertain differentiation, most often arising in the superficial extremities of children and young adults. While it has characteristic histologic features of nodular distributions of ovoid and spindle cells with blood-filled cystic cavities and a surrounding dense lymphoplasmacytic infiltrate, there is a significant morphologic spectrum, which coupled with its rarity and lack of specific immunoprofile can make diagnosis challenging. Angiomatoid fibrous histiocytoma is associated with 3 characteristic gene fusions, EWSR1-CREB1 and EWSR1-ATF1, which are also described in other neoplasms, and rarely FUS-ATF1. Angiomatoid fibrous histiocytoma is now recognized at an increasing number of sites and is known to display a variety of unusual histologic features. OBJECTIVE To review the current status of AFH, discussing putative etiology, histopathology with variant morphology and differential diagnosis, and current genetics, including overlap with other tumors harboring EWSR1-CREB1 and EWSR1-ATF1 fusions. DATA SOURCES Review of published literature, including case series, case reports, and review articles, in online medical databases. CONCLUSIONS The occurrence of AFH at several unusual anatomic sites and its spectrum of morphologic patterns can result in significant diagnostic difficulty, and correct diagnosis is particularly important because of its small risk of metastasis and death. This highlights the importance of diagnostic recognition, ancillary molecular genetic confirmation, and close clinical follow-up of patients with AFH. Further insight into the genetic and epigenetic changes arising secondary to the characteristic gene fusions of AFH will be integral to understanding its tumorigenic mechanisms.
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Affiliation(s)
- Khin Thway
- From the Sarcoma Unit, Royal Marsden Hospital, London, England
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Thway K, Gonzalez D, Wren D, Dainton M, Swansbury J, Fisher C. Angiomatoid fibrous histiocytoma: comparison of fluorescence in situ hybridization and reverse transcription polymerase chain reaction as adjunct diagnostic modalities. Ann Diagn Pathol 2015; 19:137-42. [DOI: 10.1016/j.anndiagpath.2015.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 02/03/2023]
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Jeon YK, Moon KC, Park SH, Chung DH. Primary pulmonary myxoid sarcomas with EWSR1-CREB1 translocation might originate from primitive peribronchial mesenchymal cells undergoing (myo)fibroblastic differentiation. Virchows Arch 2014; 465:453-61. [PMID: 25134518 DOI: 10.1007/s00428-014-1645-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/03/2014] [Accepted: 08/12/2014] [Indexed: 12/18/2022]
Abstract
Primary pulmonary myxoid sarcoma (PPMS) is a very rare lung tumor that has recently been shown to harbor an EWSR1-CREB1 translocation. However, the histogenesis and biological behavior of PPMS remains unclear. To provide insight into the histogenesis of PPMS, we studied surgical resection specimens of four patients, two females and two males with an age range of 26 to 65 years, all non-smokers with mild anemia. The tumors, three of which are endobronchial, measured between 4 and 13 cm. One patient developed metastasis to the contra-lateral lung 7 months after resection. Other patients remained alive without tumor for 1.5, 10, and 13 years. Fluorescence in situ hybridization (FISH) analysis with a gene break apart probe showed an EWSR1 translocation in all cases. The EWSR1-CREB1 fusion transcript was detected in all cases by reverse-transcription PCR. Immunohistochemical staining showed diffuse positive staining of the tumor cells only for vimentin. Tumor cells expressed no other myoid, epithelial, endothelial, melanocytic, myoepithelial, or neuroendocrine markers, except for smooth muscle actin and epithelial membrane antigen, which were only focally positive in individual cases. Ultrastructural analyses revealed the presence in the tumor cells of intermediate filaments with focal densities along the sub-cytoplasmic membrane as well as dense plaques. These results suggest that PPMS exhibits myofibroblastic differentiation. We conclude that PPMS is an intermediate grade malignant lung tumor harboring EWSR1 translocations, which may originate from mesenchymal cells that undergo fibroblastic or myofibroblastic differentiation.
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Affiliation(s)
- Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Smith SC, Palanisamy N, Betz BL, Tomlins SA, Mehra R, Schmidt LA, Lucas DR, Myers JL. At the intersection of primary pulmonary myxoid sarcoma and pulmonary angiomatoid fibrous histiocytoma: observations from three new cases. Histopathology 2014; 65:144-6. [PMID: 24372335 DOI: 10.1111/his.12354] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Steven C Smith
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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Fisher C. The diversity of soft tissue tumours withEWSR1gene rearrangements: a review. Histopathology 2013; 64:134-50. [DOI: 10.1111/his.12269] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/27/2013] [Indexed: 12/14/2022]
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Matsukuma S, Hisaoka M, Obara K, Kono T, Takeo H, Sato K, Hata Y. Primary pulmonary myxoid sarcoma withEWSR1-CREB1fusion, resembling extraskeletal myxoid chondrosarcoma: Case report with a review of Literature. Pathol Int 2012; 62:817-22. [PMID: 23252871 DOI: 10.1111/pin.12014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Susumu Matsukuma
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology; School of Medicine; University of Occupational and Environmental Health; Kitakyushu; Japan
| | - Kiyohaya Obara
- Division of Thoracic Surgery; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Takako Kono
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Hiroaki Takeo
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Kimiya Sato
- Department of Pathology; Japan Self Defense Forces Central Hospital; Tokyo; Japan
| | - Yoshinobu Hata
- Department of Chest Surgery; Toho University Omori Medical Center; Tokyo; Japan
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Abstract
EWSR1-CREB1 and EWSR1-ATF1 are gene fusions of which one or both have now been consistently described in 5 histopathologically and behaviorally diverse neoplasms: angiomatoid fibrous histiocytoma, conventional clear cell sarcoma (of tendons and aponeuroses), clear cell sarcoma-like tumor of the gastrointestinal tract, hyalinizing clear cell carcinoma of the salivary gland, and primary pulmonary myxoid sarcoma. Some of the tumors in this group have been described only recently, and others have been the subject of recent genetic insights contributing to their characterization. These neoplasms are all rare; yet, the increasing frequency with which EWSR1-CREB1 and EWSR1-ATF1 fusions are being described in separate entities is noteworthy. The additional molecular mechanisms by which tumors with such variable morphologic, immunohistochemical, and clinical phenotypes are generated are yet to be understood. We review the clinicopathologic and molecular features of this group of neoplasms unified by the presence of EWSR1-CREB1 and EWSR1-ATF1 genetic fusions.
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Giaj Levra M, Novello S, Scagliotti GV, Papotti M, Le Cesne A. Primary pleuropulmonary sarcoma: a rare disease entity. Clin Lung Cancer 2012; 13:399-407. [PMID: 22673623 DOI: 10.1016/j.cllc.2012.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Matteo Giaj Levra
- University of Torino, Department of Clinical and Biological Sciences, Division of Thoracic Oncology, S. Luigi Hospital, Orbassano, Italy.
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Endobronchial myxoma--case report. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012; 18:145-8. [PMID: 22261261 DOI: 10.1016/j.rppneu.2011.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 07/28/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Pulmonary myxoma is an extremely rare benign neoplasm. It is mostly parenchymal but may occasionally occur within the tracheobronchial tree. There are very few reports of endobronchial myxoma. CASE REPORT We describe a case of endobronchial myxoma in a 40-year-old female patient with a history of asthma and repeated right-sided pneumonia. Thoracic computed tomography (CT) showed medium lobe atelectasis. Fiber optic bronchoscopy revealed a polypoid, well-circumscribed tumor, causing total obstruction of the medium lobe bronchus. Biopsy of the mass was non-diagnostic. Further study included a positron emission tomography (PET) which demonstrated low metabolic activity of the tumor and no evidence of neoplasia in other location. The patient was submitted to a medium lobectomy and microscopic examination of the tumor revealed myxoid stroma with lobulated pattern, elongated and stellate cells, compatible with myxoma. CONCLUSION Pulmonary myxoma is extraordinary rare and endobronchial location is very few reported in medical literature.
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Abstract
We present clinicopathologic data on 10 pulmonary myxoid sarcomas, which are defined by distinctive histomorphologic features and characterized by a recurrent fusion gene, that appear to represent a distinct tumor entity at this site. The patients [7 female, 3 male; aged 27 to 67 y (mean, 45 y)] presented with local or systemic symptoms (n=5), symptoms from cerebral metastasis (1), or incidentally (2). Follow-up of 6 patients showed that 1 with brain metastasis died shortly after primary tumor resection, 1 developed a renal metastasis but is alive and well, and 4 are disease free after 1 to 15 years. All tumors involved pulmonary parenchyma, with a predominant endobronchial component in 8 and ranged from 1.5 to 4 cm. Microscopically, they were lobulated and composed of cords of polygonal, spindle, or stellate cells within myxoid stroma, morphologically reminiscent of extraskeletal myxoid chondrosarcoma. Four cases showed no or minimal atypia, 6 showed focal pleomorphism, and 5 had necrosis. Mitotic indices varied, with most tumors not exceeding 5/10 high-power fields. Tumors were immunoreactive for only vimentin and weakly focal for epithelial membrane antigen. Of 9 tumors, 7 were shown to harbor a specific EWSR1-CREB1 fusion by reverse transcription-polymerase chain reaction and direct sequencing, with 7 of 10 showing EWSR1 rearrangement by fluorescence in situ hybridization. This gene fusion has been described previously in 2 histologically and behaviorally different sarcomas: clear cell sarcoma-like tumors of the gastrointestinal tract and angiomatoid fibrous histiocytomas; however, this is a novel finding in tumors with the morphology we describe and that occur in the pulmonary region.
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Weissferdt A, Moran CA. Pulmonary salivary gland-type tumors with features of malignant mixed tumor (carcinoma ex pleomorphic adenoma): a clinicopathologic study of five cases. Am J Clin Pathol 2011; 136:793-8. [PMID: 22031319 DOI: 10.1309/ajcp50fbzwsackip] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We report 5 cases of pulmonary salivary gland-type tumors with features of carcinoma ex pleomorphic adenoma. Patient ages ranged from 44 to 71 years (mean, 53.8 years); 4 patients were men and 1 was a woman. In all 5 cases, the lesions were associated with the bronchial system. None of the patients had a history of a head and neck salivary gland neoplasm. Histologically, the lesions were invasive tumors containing malignant myoepithelial elements and duct-like structures embedded in a benign chondromyxoid stroma. Areas reminiscent of residual pleomorphic adenoma were noted in 2 cases. Follow-up for 3 patients revealed that 2 died 22 and 54 months after diagnosis and 1 was alive 20 months after diagnosis. The cases are characterized by unique morphologic features that, coupled with their immunoprofile, suggest the possibility that these tumors represent carcinoma ex pleomorphic adenoma, an entity that has not been well documented in the bronchopulmonary system.
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Affiliation(s)
| | - Cesar A. Moran
- Department of Pathology, M.D. Anderson Cancer Center, Houston, TX
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Kalhor N, Marom EM, Moran CA. Primary myxoma of the lung. Ann Diagn Pathol 2010; 14:178-81. [DOI: 10.1016/j.anndiagpath.2009.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 09/29/2009] [Indexed: 11/16/2022]
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Shilo K, Miettinen M, Travis WD, Timens W, Nogueira R, Franks TJ. Pulmonary Microcystic Fibromyxoma: Report of 3 Cases. Am J Surg Pathol 2006; 30:1432-5. [PMID: 17063085 DOI: 10.1097/01.pas.0000213279.53338.32] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Three cases of pulmonary myxoid tumors showing a variable degree of microcystic change are described. They are presented as incidental solitary peripheral lung nodules on routine radiologic studies. The patients included 2 women, 45 and 65 years old, and 1 man, 33 years old. Clinical work-up showed no evidence of neoplasia in other sites. Following surgical resection, no evidence of disease was observed after a mean follow-up of 48 months. The tumors ranged in size from 1 to 2.3 cm (mean 1.4 cm). Microscopically, the lesions were well circumscribed with conspicuous cystic change and myxoid stroma. Innocuous, widely-spaced, spindled to stellate tumor cells showed minimal nuclear pleomorphism and absence of mitotic activity. The myxoid stroma contained acid mucopolysaccharides, sensitive to hyaluronidase digestion. No epithelial, chondroid, neural, myofibroblastic, lipomatous or vascular differentiation was evident on immunohistochemical studies. Although these cases display cytologic features, myxoid stroma and benign clinical course characteristic of pulmonary myxomas; the presence of microcystic architecture is unique to the current series, and thus a descriptive designation "microcystic fibromyxoma" is suggested.
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Affiliation(s)
- Konstantin Shilo
- Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
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Inayama Y, Hayashi H, Ogawa N, Mitsui H, Nakatani Y. Low-grade pulmonary myxoid sarcoma of uncertain histogenesis. Pathol Int 2001; 51:204-10. [PMID: 11328537 DOI: 10.1046/j.1440-1827.2001.01180.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present report describes an unusual case of low-grade pulmonary sarcoma with extensive myxoid change in a 60-year-old man. During 30 months, the tumor enlarged gradually and thereafter rapidly to 9 cm. Preoperative biopsy and cytology gave negative results. The resected mass, located at the periphery of the right upper lobe, was well circumscribed and showed gelatinous without necrosis or hemorrhage. Histologically, the tumor was composed of slightly atypical, spindle-shaped or stellate cells, which were loosely distributed within a prominent myxoid stroma. Epithelial differentiation was not seen. Lacunar structures were occasionally evident, but no cartilaginous matrix was seen. Mitotic figures were infrequent. Immunohistochemistry failed to clarify the nature of the neoplastic cells except vimentin positivity. Histochemically, the myxoid ground substance was composed of hyaluronic acid and acid mucopolysaccharide. Electron microscopy revealed no specific differentiation other than aggregates of filaments, which were seen in a number of neoplastic cells. Flow cytometric analysis of the neoplastic cells revealed a diploid pattern. These findings indicated that the neoplasm was a low-grade myxoid sarcoma; however, a definite diagnosis could not be made. The tumor might have been a variant of extraskeletal myxoid chondrosarcoma, especially considering the histochemical results.
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Affiliation(s)
- Y Inayama
- Department of Pathology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
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