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Kasajima A, Konukiewitz B, Schlitter AM, Weichert W, Bräsen JH, Agaimy A, Klöppel G. Mesenchymal/non-epithelial mimickers of neuroendocrine neoplasms with a focus on fusion gene-associated and SWI/SNF-deficient tumors. Virchows Arch 2021; 479:1209-1219. [PMID: 34350470 PMCID: PMC8724147 DOI: 10.1007/s00428-021-03156-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
Mimickers of neuroendocrine neoplasms (NEN) include a number of important pitfall tumors. Here, we describe our experience with mesenchymal mimics of NENs to illustrate their spectrum and draw the attention particularly to a group of mesenchymal/non-epithelial neoplasms (MN) that combine epithelioid histology with neuroendocrine (NE-) features and peculiar genetic abnormalities. In a consultation series of 4498 cases collected between 2009 and 2021, 2099 neoplasms expressing synaptophysin and/or chromograninA were reviewed and analyzed. A total of 364 (18%) were diagnosed as non-NENs, while the remaining tumors were NEN. The group of mesenchymal/non-epithelial neoplasms with NE-features (MN-NE) included 31/364 (8%) cases. These mostly malignant neoplasms showed an epithelioid morphology. While all but one tumor expressed synaptophysin, mostly patchy, only 10/29 (34%) co-expressed chromograninA. A total of 13/31 (42%) of the MN-NE showed EWSR1-related gene fusions (6 Ewing sarcomas, 5 clear cell sarcomas, and 1 desmoplastic small round cell tumor, 1 neoplasm with FUS-CREM gene fusion) and 7 (23%) were SWI/SNF (SMARCB1 or SMARCA4)-deficient neoplasms. The remaining MN-NE included synovial sarcoma, sclerosing epithelioid mesenchymal neoplasm, melanoma, alveolar soft part sarcoma, solitary fibrous tumor, and chordoma. A total of 27/31 MN-NE were from the last 8 years, and 6 of them were located in the pancreas. Eleven MN-NE were initially diagnosed as neuroendocrine carcinomas (NECs). MN-NE with epithelioid features play an increasing role as mimickers of NECs. They mostly belong to tumors with gene fusions involving the EWSR1 gene, or with SWI/SNF complex deficiency. Synaptophysin expression is mostly patchy and chromograninA expression is infrequent in MN-NE of this series and data extracted from literature.
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Affiliation(s)
- Atsuko Kasajima
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany.
- The German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Björn Konukiewitz
- Department of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Anna Melissa Schlitter
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wilko Weichert
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Günter Klöppel
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
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Shah M, Gadia A, Nene A, Patel P. Management of Metastatic Spine and Hip Alveolar Soft Part Sarcoma: Case Report and Review of Literature. Asian J Neurosurg 2020; 15:1011-1015. [PMID: 33708679 PMCID: PMC7869264 DOI: 10.4103/ajns.ajns_290_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/09/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor. Primary or metastatic involvement of the spine is unusual in ASPS. In most case, it is refractory to chemotherapy and radiation. Surgical resection is the most effective intervention. We report the case of a 38-year-old female having ASPS along with metastatic spine and hip involvement treated surgically as a single-stage operation, which is the first of its kind approach to our knowledge. We present the case of a 38-year-old female with simultaneous L4 pathological fracture with symptomatic lumbar canal stenosis without focal neurology and pathological fracture of neck of femur of left hip, secondary to metastatic ASPS. Since both conditions were contributing equally to her disability and demanded early intervention, they were treated simultaneously with intralesional excision of the tumor and posterior stabilization of the spine and left hip proximal femur resection and replaced it with proximal femur endoprosthesis as a single-stage operation. Postoperatively, she had significant relief of radiculopathy and left hip pain. She was mobilized out of bed on the postoperative day 1 and was discharged from hospital on the postoperative day 6. She was given chemotherapy drug sunitib postoperative. At her last follow-up, 20 months' postoperative, she was asymptomatic and was independent in terms of activities of daily living. Metastatic ASPS of the spine and hip is a rare clinical entity. Simultaneous surgical treatment of the spine and hip pathology is technically demanding. If the conditions demands, as in our case, both of them can be managed safely in a single-stage with good midterm outcome.
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Affiliation(s)
- Munjal Shah
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Akshay Gadia
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Abhay Nene
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Priyank Patel
- Department of Spine Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
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Hei Y, Kang L, Yang X, Wang Y, Lu X, Li Y, Zhang W, Xiao L. Orbital alveolar soft part sarcoma: A report of 8 cases and review of the literature. Oncol Lett 2018; 15:304-314. [PMID: 29285193 PMCID: PMC5738708 DOI: 10.3892/ol.2017.7286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 08/23/2017] [Indexed: 11/06/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare soft tissue neoplasm. The incidence of orbital involvement is the highest in ASPS arising in the head and neck region. However, limited information is available regarding its clinical characteristics. The present study presents the clinical manifestations, imaging findings, pathological features, treatment strategies and prognosis records of 8 cases of orbital ASPS over the last 15 years in a single hospital, along with a review of the literature. Included were 3 male and 5 female patients, with the median age at presentation being 9.5 years. The mean average largest tumour diameter was 3.6 cm. A total of 5 patients underwent surgical excision of the tumour, with 2 undergoing orbital exenteration and 1 undergoing partial orbital exenteration. In total, 6 patients received postoperative radiotherapy and 2 received chemotherapy. Upon follow-up, 6 patients were doing well with no evidence of recurrence or metastasis. Local recurrence developed in 2 patients, of whom 1 succumbed following withdrawal from treatment. According to the present series and the cases mentioned in the literature, orbital alveolar soft part sarcoma has characteristics distinct from those of alveolar soft part sarcoma which arises in other locations. Orbital alveolar soft part sarcoma presents itself in a younger population with a shorter course of disease, smaller tumour size, improved prognosis, a marked association with the extraocular muscles and with the Ki-67 proliferation index possibly associated with prognosis of the disease.
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Affiliation(s)
- Yan Hei
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Li Kang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Xinji Yang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Yi Wang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Xiaozhong Lu
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Yueyue Li
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Wei Zhang
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Lihua Xiao
- Institute of Orbital Disease, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
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Zhao C, Gao X, Yang J, Li Z, Cai X, Tan T, Hou T, Yan W, Yang X, Yang C, Liu T, Xiao J. Surgical management and outcome of spinal alveolar soft part sarcoma (ASPA): a case series of five patients and literature review. World J Surg Oncol 2017; 15:39. [PMID: 28166791 PMCID: PMC5294916 DOI: 10.1186/s12957-017-1112-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/01/2017] [Indexed: 01/14/2023] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is a rare entity of soft tissue malignancies with uncommon spinal involvements. Surgical management should be the best choice of cure. Methods Five patients with spinal ASPS were interviewed retrospectively, where data was collected. The relevant literatures were also systematically examined. Thereafter, patient and surgical data were obtained and pooled for prognostic analysis. Results A total of five patients with eight surgeries were reviewed retrospectively, and three patients previously reported were also included. All patients were surgically treated, where five of them underwent additional adjuvant therapies such as chemotherapy, radiotherapy, and targeted therapy in order to manage their local and/or systematic diseases. One patient was lost in follow-up. For the remaining seven patients, the mean follow-up period was 19.7 ± 8.8 months, two succumbed to disease while five were alive at the time of the study. Conclusions Surgical management is shown to be the most important and the most effective treatment strategy for spinal ASPS, whereas adjuvant therapies made little impact. The prognostic factors for spinal ASPS are primary or metastatic lesions, neurological status, disease progression, systematic conditions, and resection approaches.
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Affiliation(s)
- Chenglong Zhao
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
| | - Xin Gao
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Jian Yang
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Zhenxi Li
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Xiaopan Cai
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Tao Tan
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Tianhui Hou
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.,College of Physical Education and Health, East China Normal University, Minhang District, Dongchuan Rd 500#, Shanghai, China
| | - Wangjun Yan
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Xinghai Yang
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China
| | - Cheng Yang
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
| | - Tielong Liu
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
| | - Jianru Xiao
- Spine Tumor Center, Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu District, Fengyang Rd 415#, Shanghai, China.
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Abstract
In this article, we focus on the histologic features, differential diagnosis, and potential pitfalls in the diagnosis of epithelioid sarcoma, alveolar soft part sarcoma, clear-cell sarcoma, ossifying fibromyxoid tumor, and malignant extrarenal rhabdoid tumor. Numerous other soft tissue tumors also may have epithelioid variants or epithelioid features. Examples include epithelioid angiosarcoma, epithelioid malignant peripheral nerve sheath tumor, epithelioid gastrointestinal stromal tumor, and perivascular epithelioid cell tumor, among others.
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Affiliation(s)
- Aaron W James
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90077, USA
| | - Sarah M Dry
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90077, USA.
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James AW, Chang L, Levine B, Dry SM. Clavicular and meningeal alveolar soft part sarcoma: An unusual case and literature review. J Orthop 2014; 11:48-53. [PMID: 24719534 DOI: 10.1016/j.jor.2013.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/29/2013] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Alveolar soft part sarcoma (ASPS) commonly arises in the soft tissue of the lower extremities. Primary bone involvement is rare. METHODS/RESULTS We report a 23-year-old male who presented with pathologic fracture of the clavicle, and diagnosis of clavicular ASPS. Workup demonstrated a lumbar meningeal mass, also involving the vertebral bodies. CONCLUSIONS Few cases of primary bone ASPS have been identified. Most common primary bone involvement includes the fibula, ilium and tibia. Likewise, meningeal involvement is quite rare. In summary, primary bone ASPS is rare and may involve the clavicle. Meningeal involvement is likewise rare, and presumably represents metastatic spread.
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Affiliation(s)
- Aaron W James
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Le Chang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Benjamin Levine
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sarah M Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Zadnik PL, Yurter A, DeLeon R, Molina CA, Groves ML, McCarthy E, Sciubba DM. Alveolar soft-part sarcoma in the sacrum: a case report and review of the literature. Skeletal Radiol 2014; 43:115-20. [PMID: 24092236 DOI: 10.1007/s00256-013-1737-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 02/02/2023]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare disease of the soft tissue. Although the disease is rare, it is refractory to chemotherapy and radiation. En bloc surgical resection offers the best chance of cure. In this article we report the case of a 28-year-old woman who presented with buttock and leg pain, bowel, bladder and gait impairment and a large mass in the sacrum. Following surgical excision, the lesion was proven to be ASPS. On pathology, the mass was TFE3 (transcription factor E3) positive, indicating the presence of the ASPL-TFE3 (novel gene-transcription factor) translocation. Following surgery, the patient had improvement in her pain and ambulation; however, she refused adjuvant therapy to pursue hospice care and succumbed to her disease 2 years after surgery. On a review of the literature, it was found that ASPS of the bone constitutes a rare and formidable subset of this disease. Further, metastases related to ASPS are common in the lungs, liver, brain, and lymph nodes. The degree of dissemination is a predictor of outcome, with 5-year survival of 81-88% in patients with local disease and only 20-46% in patients with metastatic disease at the time of presentation. Brain metastases at the time of presentation portend the worst prognosis.
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Affiliation(s)
- Patricia L Zadnik
- The Johns Hopkins Hospital, 1550 Orleans Street CRB II Room 264, Baltimore, MD, 21207, USA
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Primary alveolar soft part sarcoma of vertebra: a case report and literature review. Skeletal Radiol 2009; 38:825-9. [PMID: 19347336 DOI: 10.1007/s00256-009-0696-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 03/15/2009] [Accepted: 03/23/2009] [Indexed: 02/02/2023]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, which rarely occurs in bone. We present a case of ASPS in a 23-year-old man with a 2-month history of back pain. Computed tomography scanning and magnetic resonance images demonstrated a destructive process in the 12th thoracic vertebra associated with a unilateral soft tissue mass. The tumor showed evidence of hypervascularity on MRI; it obviously was enhanced on T1-weighted images after injection of Gd-GDPA, and signal voids were shown on all pulse sequences which may help to differentiate ASPS from other tumors of the vertebra. We believe that this is the first case of ASPS arising in a vertebra.
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