1
|
Brodsky CN, Bucala MD, Abdulfatah EM, Siegel GW. Extraskeletal Myxoid Chondrosarcoma: Retrospective Case Series Examining Prognostic Factors, Treatment Approaches, and Oncologic Outcomes. Am J Clin Oncol 2023; 46:172-177. [PMID: 36825763 DOI: 10.1097/coc.0000000000000988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Extraskeletal myxoid chondrosarcoma (EMC) is an ultrarare soft tissue sarcoma, and a limited number of studies are published regarding its clinical course and efficacy of treatment. The goal of this retrospective case series is to explore patient characteristics, treatment approaches, and oncologic outcomes to help inform future EMC management. METHODS All patients with a diagnosis of EMC seen at the University of Michigan Sarcoma Center between 1998 and 2021 were identified. A chart review was performed to analyze demographics, tumor characteristics, treatments, and outcomes. RESULTS Forty-four patients with EMC were identified. The median follow-up was 49.8 months. The median age at diagnosis was 57 (range: 25 to 79), and 35 patients (80%) were male. Thirty-four patients (77%) had locoregional disease at diagnosis, and 26 patients (59%) ultimately developed metastatic disease. After locoregional curative-intent surgery, 15 patients had documented recurrence, of which 11 were metastatic (73%). Five-year overall survival was 79% for all patients, 86% for locoregional disease, and 58% for metastatic disease; for locoregional disease, 5-year disease-free and metastasis-free survival post-surgery were 43% and 53%, respectively; 1-year progression-free survival for metastatic disease from the start of first-line systemic therapy was 43%. Older age was the only factor statistically associated with improved prognosis, although perioperative radiotherapy, lower histologic grade, and negative margins also had directional associations with outcomes. CONCLUSIONS The data in this patient series are generally consistent with published literature on EMC and demonstrate a high recurrence rate, high propensity for metastasis, and high rate of progression of metastatic disease on systemic therapy.
Collapse
|
2
|
Gusho CA, King D, Ethun CG, Cardona K, Harrison Howard J, Tran TB, Poultsides G, Tseng J, Roggin KK, Fields RC, Cullinan DR, Chouliaras K, Votanopoulos K, Grignol VP, Bedi M. Extraskeletal myxoid chondrosarcoma: Clinicopathological features and outcomes from the United States sarcoma collaborative database. J Surg Oncol 2022; 126:1533-1542. [PMID: 35962783 DOI: 10.1002/jso.27062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUNDS AND OBJECTIVES This investigation described clinicopathological features and outcomes of extraskeletal myxoid chondrosarcoma (EMC) patients. METHODS EMC patients were identified from the United States Sarcoma Collaborative database between 2000 and 2016. Overall survival (OS) and recurrence-free survival (RFS) were calculated, and prognostic factors were analyzed. RESULTS Sixty individuals with a mean age of 55 years were included, and 65.0% (n = 39) were male. 73.3% (n = 44) had a primary tumor. A total of 41.6% (n = 25) developed tumor relapse following resection. The locoregional recurrence rate was 30.0% (n = 18/60), and mean follow-up was 42.7 months. The 5-year OS was 71.0%, while the 5-year RFS was 41.4%. On multivariate analysis for all EMC, chemotherapy (hazard ratio [HR], 6.054; 95% confidence interval [CI], 1.33-27.7; p = 0.020) and radiation (HR, 5.07, 95% CI, 1.3-20.1; p = 0.021) were independently predictive of a worse RFS. Among patients with primary EMC only, the 5-year OS was 85.3%, with a 30.0% (n = 12) locoregional recurrence rate, though no significant prognostic factors were identified. CONCLUSIONS Long-term survival with EMC is probable, however there exists a high incidence of locoregional recurrence. While chemotherapy and radiation were associated with a worse RFS, these findings were likely confounded by recurrent disease as significance was lost in the primary EMC-only subset.
Collapse
Affiliation(s)
| | - David King
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - J Harrison Howard
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, CA, USA
| | | | | | | | - Ryan C Fields
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | | - Valerie P Grignol
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
3
|
Wilbur HC, Robinson DR, Wu YM, Kumar-Sinha C, Chinnaiyan AM, Chugh R. Identification of Novel PGR-NR4A3 Fusion in Extraskeletal Myxoid Chondrosarcoma and Resultant Patient Benefit From Tamoxifen Therapy. JCO Precis Oncol 2022; 6:e2200039. [PMID: 36103645 PMCID: PMC9489176 DOI: 10.1200/po.22.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/24/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- H. Catherine Wilbur
- Department of Medicine, Division of Hematology and Oncology, and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Dan R. Robinson
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Chandan Kumar-Sinha
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Rashmi Chugh
- Department of Medicine, Division of Hematology and Oncology, and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| |
Collapse
|
4
|
Zhu ZY, Wang YB, Li HY, Wu XM. Primary intracranial extraskeletal myxoid chondrosarcoma: A case report and review of literature. World J Clin Cases 2022; 10:4301-4313. [PMID: 35665108 PMCID: PMC9131214 DOI: 10.12998/wjcc.v10.i13.4301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary intracranial extraskeletal myxoid chondrosarcoma (EMC) is an extremely rare low- to intermediate-grade malignant soft tissue sarcoma, and only 15 cases have been reported in the literature. Due to its rarity, clinical data and research on this tumor type are extremely limited, the pathogenesis and histological origin are still unclear, and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined.
CASE SUMMARY We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo, and his health status deteriorated during the last week. CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus. Brain magnetic resonance imaging (MRI) showed a 3.4 cm × 3.0 cm sized, well-defined, round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus. The entire lesion was removed via supratentorial craniotomy and microsurgery. Postoperative pathological diagnosis indicated primary intracranial EMC. Subsequently, the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge. At present, it is 12 mo after surgery, with regular postoperative follow-up and regular MRI examinations, that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor, and the patient has returned to normal life.
CONCLUSION Currently, the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy. Long-term follow-up is also necessary for patients.
Collapse
Affiliation(s)
- Zi-You Zhu
- Department of Neurosurgery, The First Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Bo Wang
- Department of Neurosurgery, The First Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
| | - Han-Yi Li
- Department of Orthodontics, Hospital of Stomatology of Jilin University, Changchun 130021, Jilin Province, China
| | - Xin-Min Wu
- Department of Neurosurgery, The First Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
5
|
Fice MP, Lee L, Kottamasu P, Almajnooni A, Cohn MR, Gusho CA, Gitelis S, Blank AT. Extraskeletal myxoid chondrosarcoma: A case series and review of the literature. Rare Tumors 2022; 14:20363613221079754. [PMID: 35251555 PMCID: PMC8891938 DOI: 10.1177/20363613221079754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant soft tissue sarcoma (STS) that accounts for less than 3% of all soft tissue tumors. The conventional treatment for primary EMC is wide local excision with or without radiation therapy. Materials and Methods This study was a retrospective review of all EMC cases treated within a single institution between 1992 and 2019. EMC was diagnosed using a combination of histologic morphology and immunostaining, with confirmatory fluorescent in situ hybridization. Overall survival (OS) and disease-specific survival (DSS) were defined using Kaplan–Meier analysis. Results Fifteen patients were evaluated, including 11 males and four females. The average age at presentation was 51.7 ± 20.4 years and the mean follow-up time was 61.5 months (range, 5–286 months). The average resected tumor size at largest dimension was 7.14 cm (range, 2.4–18.7). Twelve of fifteen (80%) patients underwent wide local excision, and nine of the twelve (75%) underwent local radiation therapy. The 1-, 5-, and 10-year OS was 80% (95% CI, 59.8–100), 72% (95% CI, 48.5–95.5), and 72% (95% CI, 48.5–95.5), respectively. The 1-, 5-, and 10-year DSS was 92.3% (95% CI, 77.8–100), 83.1% (95% CI, 61.5–100), and 83.1% (95% CI, 61.5–100), respectively. At last follow-up, 11 patients were alive and ten (90.9%) were disease free. Conclusions Extraskeletal myxoid chondrosarcoma is a very rare STS most often seen in males and in the extremities. Our cohort was too small to provide meaningful statistical analysis; however, we observed lower rates of local recurrence in patients treated with radiation.
Collapse
Affiliation(s)
- Michael P Fice
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Linus Lee
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Pavan Kottamasu
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | | | - Matthew R Cohn
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Charles A Gusho
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
6
|
Brown JM, Rakoczy K, Pretell-Mazzini J. Extraskeletal myxoid chondrosarcoma: Clinical features and overall survival. Cancer Treat Res Commun 2022; 31:100530. [PMID: 35144048 DOI: 10.1016/j.ctarc.2022.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Extraskeletal myxoid chondrosarcoma is a rare form of soft tissue sarcoma characterized by a unique chromosomal translocation involving the NR4A3 gene on chromosome 9. It is most frequently diagnosed in the proximal extremities of older adult males and is notable for its insidious growth with predilection for local recurrence and metastasis. Currently, extraskeletal myxoid chondrosarcoma is managed with wide resection, with recent investigations supporting the utility of adjuvant radiation and novel chemotherapeutic strategies. METHODOLOGY A retrospective study was performed with the Surveillance, Epidemiology, and End-Results (SEER) database, which was searched for cases of extraskeletal myxoid chondrosarcoma diagnosed between years 2004 and 2015. Demographic variables were assessed, as well as Collaborative Staging variables including tumor size, metastatic disease, grade, and lymph node involvement. Cases were stratified according to the anatomic site of the primary tumor and were described by therapeutic intervention. A multivariate Cox proportional hazards model evaluated predictive factors for poor survival, and Kaplan-Meier analyses assessed effects of various staging, demographic, and therapeutic variables on overall survival. RESULTS There were 270 cases of extraskeletal myxoid chondrosarcoma reviewed in this study, which were diagnosed most frequently in the lower limb or hip of older adult males. The 5-year overall survival was 76.5% and was worse on univariate assessment for patients with age > 60, high histologic grade, pelvic location, tumor size > 8.0 cm, metastatic or nodal spread, and in patients without surgical intervention. The Cox regression predicted significantly worse survival for older age, larger tumor size, non-surgical status, and high tumor grade. Metastasis did not significantly predict worse survival on multivariate assessment, and neither chemotherapy nor radiotherapy provided a discernable improvement in survival in this cohort. DISCUSSION AND CONCLUSION As a rare soft tissue sarcoma, many of the presenting features and survival outcomes of extraskeletal myxoid chondrosarcoma remain poorly defined due to the limited prevalence of this disease. The findings of this study suggest the overall survival may be worse than previously reported, and poor prognostic factors are those associated with worse survival in other soft tissue sarcomas, including high histologic grade, older age, larger tumor size, and lack of wide resection. Radiation and chemotherapy did not demonstrably improve survival for patients with localized or metastatic disease.
Collapse
Affiliation(s)
- Jeffrey Mark Brown
- University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Juan Pretell-Mazzini
- University of Miami, Department of Orthopedics, Musculoskeletal Oncology, Miami, FL, United States
| |
Collapse
|
7
|
Li W, Dong S, Wang H, Wu R, Wu H, Tang ZR, Zhang J, Hu Z, Yin C. Risk analysis of pulmonary metastasis of chondrosarcoma by establishing and validating a new clinical prediction model: a clinical study based on SEER database. BMC Musculoskelet Disord 2021; 22:529. [PMID: 34107945 PMCID: PMC8191035 DOI: 10.1186/s12891-021-04414-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023] Open
Abstract
Background The prognosis of lung metastasis (LM) in patients with chondrosarcoma was poor. The aim of this study was to construct a prognostic nomogram to predict the risk of LM, which was imperative and helpful for clinical diagnosis and treatment. Methods Data of all chondrosarcoma patients diagnosed between 2010 and 2016 was queried from the Surveillance, Epidemiology, and End Results (SEER) database. In this retrospective study, a total of 944 patients were enrolled and randomly splitting into training sets (n = 644) and validation cohorts(n = 280) at a ratio of 7:3. Univariate and multivariable logistic regression analyses were performed to identify the prognostic nomogram. The predictive ability of the nomogram model was assessed by calibration plots and receiver operating characteristics (ROCs) curve, while decision curve analysis (DCA) and clinical impact curve (CIC) were applied to measure predictive accuracy and clinical practice. Moreover, the nomogram was validated by the internal cohort. Results Five independent risk factors including age, sex, marital, tumor size, and lymph node involvement were identified by univariate and multivariable logistic regression. Calibration plots indicated great discrimination power of nomogram, while DCA and CIC presented that the nomogram had great clinical utility. In addition, receiver operating characteristics (ROCs) curve provided a predictive ability in the training sets (AUC = 0.789, 95% confidence interval [CI] 0.789–0.808) and the validation cohorts (AUC = 0.796, 95% confidence interval [CI] 0.744–0.841). Conclusion In our study, the nomogram accurately predicted risk factors of LM in patients with chondrosarcoma, which may guide surgeons and oncologists to optimize individual treatment and make a better clinical decisions. Trial registration JOSR-D-20-02045, 29 Dec 2020.
Collapse
Affiliation(s)
- Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, 712000, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, 712000, China
| | - Shengtao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - Haosheng Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, 130000, China
| | - Rilige Wu
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, 100853, China.,National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Huitao Wu
- Intelligent Healthcare Team, Baidu Inc., Beijing, 100089, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Junyan Zhang
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, 100853, China.,National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhaohui Hu
- Department of Spine Surgery, Liuzhou People's Hospital, Liuzhou, 545000, China.
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, 999078, China.
| |
Collapse
|
8
|
Stacchiotti S, Baldi GG, Morosi C, Gronchi A, Maestro R. Extraskeletal Myxoid Chondrosarcoma: State of the Art and Current Research on Biology and Clinical Management. Cancers (Basel) 2020; 12:cancers12092703. [PMID: 32967265 PMCID: PMC7563993 DOI: 10.3390/cancers12092703] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The aim of this review is to provide an overview of the biological basis of pathogenesis and current research in extraskeletal myxoid chondrosarcoma (EMC), together with the state of the art of treatment for localized and advanced disease. EMC is an ultra-rare sarcoma sub-type, more often arising from the soft tissues, marked by specific molecular features consisting in rearrangement of the NR4A3 gene, identified in recent years and very useful to distinguish EMC from other mimics. Available pharmacological treatments in particular are discussed, with a focus on the most recent results and future perspectives. Abstract Extraskeletal myxoid chondrosarcoma (EMC) is an ultra-rare mesenchymal neoplasm with uncertain differentiation, which arises mostly in the deep soft tissue of proximal extremities and limb girdles. EMC is marked by a translocation involving the NR4A3 gene, which can be fused in-frame with different partners, most often EWSR1 or TAF1. Although EMC biology is still poorly defined, recent studies have started shedding light on the specific contribution of NR4A3 chimeric proteins to EMC pathogenesis and clinical outcome. Standard treatment for localized disease is surgery, plus or minus radiation therapy with an expected prolonged survival even though the risk of relapse is about 50%. In advanced cases, besides the standard chemotherapy currently used for soft tissue sarcoma, antiangiogenic agents have recently shown promising activity. The aim of this review is to provide the state of the art of treatment for localized and advanced disease, with a focus on pharmacological treatments available for EMC. The biological basis of current research and future perspectives will be also discussed.
Collapse
Affiliation(s)
- Silvia Stacchiotti
- Medical Oncology Unit 2, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2390-2803; Fax: +39-02-2390-2804
| | - Giacomo Giulio Baldi
- “Sandro Pitigliani” Medical Oncology Department, Hospital of Prato, 59100 Prato, Italy;
| | - Carlo Morosi
- Deparment of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Roberta Maestro
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, 33081 Aviano, Italy;
| |
Collapse
|
9
|
Wagner MJ, Chau B, Loggers ET, Pollack SM, Kim TS, Kim EY, Thompson MJ, Harwood JL, Cranmer LD. Long-term Outcomes for Extraskeletal Myxoid Chondrosarcoma: A SEER Database Analysis. Cancer Epidemiol Biomarkers Prev 2020; 29:2351-2357. [PMID: 32856598 DOI: 10.1158/1055-9965.epi-20-0447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/24/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMCS) is a rare tumor that typically has an indolent course but high rate of recurrence. We queried the Surveillance, Epidemiology, and End Results (SEER) database to assess factors associated with metastasis, treatment, and survival. METHODS We queried the SEER 1973-2016 database for patients with myxoid chondrosarcoma (ICD-O-3: 9231/3). Kaplan-Meier analyses and Cox proportional hazard models assessed effects on overall survival (OS) of demographics and clinical characteristics. Logistic regression assessed associations between tumor location and distant disease. Primary analysis was a complete case analysis; multiple imputation (MI) was used in a sensitivity analysis. RESULTS Locoregional disease (LRD) was found in 373 (85%) of patients. In univariate analysis with LRD, surgery correlated with superior OS [HR = 0.27; 95% confidence interval (CI), 0.16-0.47]; chemotherapy and radiotherapy associated with inferior OS (HR = 1.90; 95% CI, 1.11-3.27 and HR = 1.45; 95% CI, 1.03-2.06, respectively). No treatment modality associated with OS in the adjusted, complete case model. In the adjusted sensitivity analysis, surgery associated with superior outcomes (HR = 0.36; 95% CI, 0.19-0.69). There was no OS difference by primary tumor site. 10-year OS with distant disease was 10% (95% CI, 2%-25%). CONCLUSIONS Surgery in LRD associated with improved OS in univariate analysis and adjusted models correcting for missing data. There was no OS benefit with chemotherapy or radiotherapy. IMPACT This represents the largest report of EMCS with long-term follow-up. Despite the reputedly indolent nature of EMCS, outcomes with metastatic disease are poor. We provide OS benchmarks and guidance for stratification in future prospective trials.
Collapse
Affiliation(s)
- Michael J Wagner
- Division of Medical Oncology, University of Washington, Seattle, Washington. .,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bonny Chau
- Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Elizabeth T Loggers
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Seth M Pollack
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Teresa S Kim
- Department of Surgery, University of Washington, Seattle, Washington
| | - Edward Y Kim
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Matthew J Thompson
- Department of Orthopedic Surgery, University of Washington, Seattle, Washington
| | - Jared L Harwood
- Department of Orthopedic Surgery, University of Washington, Seattle, Washington
| | - Lee D Cranmer
- Division of Medical Oncology, University of Washington, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
10
|
Claxton MR, Reynolds G, Wenger DE, Rose PS, Houdek MT. Extraskeletal myxoid chondrosarcoma: A high incidence of metastatic disease to lymph nodes. J Surg Oncol 2020; 122:1662-1667. [PMID: 32808356 DOI: 10.1002/jso.26179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (ESMC) is a rare type of soft-tissue sarcoma with limited series reporting outcome of treatment. Currently there is limited data on the incidence and impact on patient outcome in those with metastatic disease to lymph nodes in ESMC. METHODS Thirty (21 males, 9 females) patients, mean age 50 ± 16 years, with ESMC were reviewed. The tumors were most commonly located in the lower extremity (n = 23, 77%) and the mean tumor size and volume were 9 ± 5 cm and 490 ± 833 cm3 . Mean follow up was 7 ± 4 years. RESULTS Six (20%) patients either presented (n = 3, 10%) or developed (n = 3, 10%) lymph node metastatic disease. When comparing patients without, with lymph node metastasis and metastasis elsewhere, patients with lymph nodes metastasis had worse survival than those without metastasis, however better 10-year disease specific survival than those with metastasis elsewhere (100% vs 62% vs 0%; P < .001). CONCLUSION There is a high incidence of lymph node metastatic disease in patients with ESMC. Although survival in these patients is worse compared to those without metastasis, their survival is better than those with metastasis elsewhere. Due to the high incidence of lymph node metastatic disease, preoperative staging of the lymph node should be considered.
Collapse
Affiliation(s)
- Matthew R Claxton
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Grace Reynolds
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
11
|
Paioli A, Stacchiotti S, Campanacci D, Palmerini E, Frezza AM, Longhi A, Radaelli S, Donati DM, Beltrami G, Bianchi G, Barisella M, Righi A, Benini S, Fiore M, Picci P, Gronchi A. Extraskeletal Myxoid Chondrosarcoma with Molecularly Confirmed Diagnosis: A Multicenter Retrospective Study Within the Italian Sarcoma Group. Ann Surg Oncol 2020; 28:1142-1150. [PMID: 32572850 DOI: 10.1245/s10434-020-08737-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma of uncertain origin, marked by specific chromosomal translocations involving the NR4A3 gene, and usually characterized by an indolent course. Surgery (with or without radiotherapy) is the treatment of choice in localized disease. The treatment for advanced disease remains uncertain. In order to better evaluate prognostic factors and outcome, a retrospective pooled analysis of patients with EMC treated at three Italian Sarcoma Group (ISG) referral centers was carried out. METHODS All patients with localized EMC surgically treated from 1989 to 2016 were identified. Diagnosis was centrally reviewed according to WHO 2013. Only patients with NR4A3 rearrangement were included. RESULTS Sixty-seven patients were identified: 13 (20%) female, 54 (80%) male. Median age was 56 years (range 18-84). Numbers and type of translocation were: 50 (80%) NR4A3-EWS, 10 (16%) NR4A3-TAF15, 1 (2%) NR4A3-TCF12, and 1 (2%) NR4A3-TFG. Median follow-up was 55 months (range 2-312). Five- and ten-year overall survival rates were 94% (86-100 95%CI) and 84% (69-98 95%CI). Thirty-five (52%) patients relapsed: 9 had local recurrence (LR) and 26 had distant metastasis (5 with concomitant LR). The 5- and 10-year disease-free survival rates (DFS) were 51% (38-65 95%CI) and 20% (7-33 95%CI). Size of the primary tumor was significantly related to distant metastasis-free survival (DMFS) (p = 0.004). Patients carrying the NR4A3-EWS translocation had a trend in favor of better DFS (p = 0.08) and DMFS (p = 0.09) compared with the patients with NR4A3-TAF15. CONCLUSIONS Prolonged survival can be expected in patients with EMC, in spite of a high rate of recurrence. Size is significantly associated with distant relapse. The type of NR4A3 translocation could influence outcome.
Collapse
Affiliation(s)
- Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Silvia Stacchiotti
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Domenico Campanacci
- Department of Orthopedic Oncology, Azienda Ospedaliera Careggi, Florence, Italy
| | | | - Anna Maria Frezza
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Beltrami
- Department of Orthopedic Oncology, Azienda Ospedaliera Careggi, Florence, Italy
| | - Giuseppe Bianchi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefania Benini
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Piero Picci
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Italian Sarcoma Group (I.S.G.), San Lazzaro di Savena, Bologna, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
12
|
Extraskeletal Myxoid Chondrosarcomas: Combined Modality Therapy With Both Radiation and Surgery Improves Local Control. Am J Clin Oncol 2020; 42:744-748. [PMID: 31436747 DOI: 10.1097/coc.0000000000000590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We evaluated our experience treating patients with localized extraskeletal myxoid chondrosarcomas (EMCs) to evaluate outcomes and relapse rates in order to better inform treatment decisions for these rare soft tissue sarcomas. MATERIALS AND METHODS We reviewed the records of 41 consecutive patients with localized EMC treated at our institution from 1990 to 2016. Most patients (n=33, 80%) received combined modality therapy with surgery and radiation therapy, whereas only 8 (20%) underwent surgery alone. The Kaplan-Meier method was used to estimate rates of overall survival, disease-specific survival, local control (LC), and distant metastatic-free survival (DMFS). RESULTS Median follow-up time was 94 months (range, 8 to 316). The 10-year LC, DMFS, disease-specific survival, and overall survival rates were 90%, 69%, 85%, and 66%, respectively. There were 5 patients (12%) with local relapse at a median time of 75 months (range, 13 to 176). On univariate analysis, the only significant factor associated with poorer LC was the use of surgery alone (10 y LC, 63% vs. 100% for combined modality therapy, P=0.004), which remained the only factor also significant on the multivariable analysis (P=0.02; hazard ratio [HR], 12.7; 95% confidence interval [CI], 1.4-115.3). In total, 13 patients (32%) developed distant metastatic at a median time of 28 months (range, 3 to 154). Interestingly, local recurrence was the only factor associated with poorer DMFS on multivariate analysis (P=0.04; HR, 3.9; 95% CI, 1.1-14.7). CONCLUSIONS For patients with EMC, surgery alone was associated with a higher risk of local recurrence. Therefore, we recommend optimal local therapeutic strategies upfront with both surgery and radiation therapy to reduce the risk of local and ultimately distant recurrence.
Collapse
|
13
|
Stacchiotti S, Ferrari S, Redondo A, Hindi N, Palmerini E, Vaz Salgado MA, Frezza AM, Casali PG, Gutierrez A, Lopez-Pousa A, Grignani G, Italiano A, LeCesne A, Dumont S, Blay JY, Penel N, Bernabeu D, de Alava E, Karanian M, Morosi C, Brich S, Dagrada GP, Vallacchi V, Castelli C, Brenca M, Racanelli D, Maestro R, Collini P, Cruz J, Martin-Broto J. Pazopanib for treatment of advanced extraskeletal myxoid chondrosarcoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol 2019; 20:1252-1262. [DOI: 10.1016/s1470-2045(19)30319-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022]
|
14
|
Paoluzzi L, Ghesani M. Extraskeletal myxoid chondrosarcoma with massive pulmonary metastases. Clin Sarcoma Res 2018. [PMID: 30534357 DOI: 10.1186/s13569-018-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant mesenchymal neoplasm of uncertain differentiation characterized by rearrangements of the NR4A3 gene. EMC often affects adults around the age of 50 and arise in the deep tissues of the proximal extremities and limb girdles. EMC is characterized by indolent growth rate but strong tendency to local recurrence and metastatic spread. No systemic treatment is specifically approved by the FDA for this disease and surgery has been traditionally the only potentially curative strategy. Case presentation A 41-year-old Caucasian woman originally presented with a 14.8 cm left thigh mass. She was managed with wide local resection but after 2 years she developed recurrent disease in the pelvis and in the lungs; the lung involvement was characterized by innumerable nodules without any significant respiratory symptoms. After failing three clinical trials, she experienced prolonged disease control while on treatment with the tyrosine kinase inhibitor (TKI) pazopanib and radiation therapy delivered to the pelvic lesion. Dose reduction of pazopanib due to severe diarrhea was followed by rapid disease progression in the pelvis requiring vascular stenting; increase in tumor growth after discontinuation of a TKI has been described in other malignancies and is a possibility in this specific patient. Conclusion While surgical management of EMC with or without radiation therapy is still the preferable approach when feasible, small series support the use of tyrosine kinase inhibitors and possible new immunotherapies in selected patients. Basket trials focusing on diseases with unique genomic features such as EMC will hopefully provide a better understanding of new options for care.
Collapse
Affiliation(s)
- Luca Paoluzzi
- 1Department of Medicine, Sarcoma Medical Oncology, NYU Langone Medical Center, 160 East 34th Street, New York, NY 10016 USA
| | - Munir Ghesani
- 2Department of Radiology, NYU Langone Medical Center, New York, NY USA
| |
Collapse
|
15
|
Paoluzzi L, Ghesani M. Extraskeletal myxoid chondrosarcoma with massive pulmonary metastases. Clin Sarcoma Res 2018; 8:20. [PMID: 30534357 PMCID: PMC6280406 DOI: 10.1186/s13569-018-0108-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant mesenchymal neoplasm of uncertain differentiation characterized by rearrangements of the NR4A3 gene. EMC often affects adults around the age of 50 and arise in the deep tissues of the proximal extremities and limb girdles. EMC is characterized by indolent growth rate but strong tendency to local recurrence and metastatic spread. No systemic treatment is specifically approved by the FDA for this disease and surgery has been traditionally the only potentially curative strategy. Case presentation A 41-year-old Caucasian woman originally presented with a 14.8 cm left thigh mass. She was managed with wide local resection but after 2 years she developed recurrent disease in the pelvis and in the lungs; the lung involvement was characterized by innumerable nodules without any significant respiratory symptoms. After failing three clinical trials, she experienced prolonged disease control while on treatment with the tyrosine kinase inhibitor (TKI) pazopanib and radiation therapy delivered to the pelvic lesion. Dose reduction of pazopanib due to severe diarrhea was followed by rapid disease progression in the pelvis requiring vascular stenting; increase in tumor growth after discontinuation of a TKI has been described in other malignancies and is a possibility in this specific patient. Conclusion While surgical management of EMC with or without radiation therapy is still the preferable approach when feasible, small series support the use of tyrosine kinase inhibitors and possible new immunotherapies in selected patients. Basket trials focusing on diseases with unique genomic features such as EMC will hopefully provide a better understanding of new options for care.
Collapse
Affiliation(s)
- Luca Paoluzzi
- 1Department of Medicine, Sarcoma Medical Oncology, NYU Langone Medical Center, 160 East 34th Street, New York, NY 10016 USA
| | - Munir Ghesani
- 2Department of Radiology, NYU Langone Medical Center, New York, NY USA
| |
Collapse
|
16
|
Santos F, Martins C, Lemos MM. Fine-needle aspiration features of extraskeletal myxoid chondrosarcoma: A study of cytological and molecular features. Diagn Cytopathol 2018; 46:950-957. [DOI: 10.1002/dc.24028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/03/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Filipa Santos
- Serviço de Anatomia Patológica; Instituto Português de Oncologia de Lisboa Francisco Gentil; Lisbon Portugal
| | - Carmo Martins
- Unidade de Investigação em Patobiologia Molecular; Instituto Português de Oncologia de Lisboa Francisco Gentil; Lisbon Portugal
| | - Maria M. Lemos
- Serviço de Anatomia Patológica; Instituto Português de Oncologia de Lisboa Francisco Gentil; Lisbon Portugal
| |
Collapse
|
17
|
Batsis ID, Offenbacher R, Rybinski B, Pawel B, Weiser DA. Systemic manifestations of extraskeletal myxoid chondrosarcoma associated with a novel t(2;22)(q34;q12) EWS translocation in a child and a review of the literature. Pediatr Hematol Oncol 2018; 35:434-441. [PMID: 30776935 DOI: 10.1080/08880018.2018.1557766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC), a soft-tissue sarcoma with unique clinicopathologic features and characteristic chromosomal translocations, is extremely rare in the pediatric population. We, herein, present the case of a 7-year-old boy with profound microcytic hypochromic anemia, poor weight gain and a mid-thoracic paraspinal mass that was identified as EMC. Systemic manifestations of localized, nonmetastatic EMC have never been described in the pediatric population, yet our patient's anemia and poor weight gain resolved after successful surgical resection of the tumor, suggesting that localized EMC can present with systemic manifestations. The tumor also contained a novel t(2;22)(q34;q12) translocation involving the EWSR1 gene, which is consistent with additional reports suggesting that a growing list of translocations can drive formation of, and potential new management strategies for, EMC.
Collapse
Affiliation(s)
- Irini D Batsis
- a Johns Hopkins Children's Center , Baltimore , Maryland , USA
| | | | - Brad Rybinski
- c Albert Einstein College of Medicine , Bronx , New York , USA
| | - Bruce Pawel
- d Children's Hospital at Philadelphia , Pennsylvania , USA
| | - Daniel A Weiser
- b The Children's Hospital at Montefiore , Bronx , New York , USA.,c Albert Einstein College of Medicine , Bronx , New York , USA
| |
Collapse
|
18
|
Lu M, Zhou Z, Lei Z, Li H, Boriani S. Huge myxoid chondrosarcoma expanded into the thoracic cavity with spinal involvement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:25-30. [PMID: 29974237 DOI: 10.1007/s00586-018-5689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/20/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE En bloc resection is the treatment of choice of myxoid chondrosarcoma. These tumors can produce huge masses. Anatomical constraints limit the possibility to perform en bloc resection in the spine. METHODS A very huge myxoid chondrosarcoma (14.2 × 10.8 × 11.4 cm) arising from T2 to T5 and invading the whole higher left pleural cavity was observed. Surgical planning according to WBB staging system was performed. RESULTS The tumor was successfully submitted to en bloc resection achieving a tumor-free margin as demonstrated by the pathologist's report. CONCLUSIONS A careful planning and a multidisciplinary collaboration make possible to perform en bloc resection even in apparently impossible cases.
Collapse
Affiliation(s)
- Ming Lu
- Department of Orthopedic, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, 510630, China
| | - Zhongxin Zhou
- Department of Interventional Vascular Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zixiong Lei
- Department of Orthopedic, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.,Academy of Orthopaedics, Guangdong Province, Guangzhou, 510630, China
| | - Haomiao Li
- Department of Orthopedic, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China. .,Academy of Orthopaedics, Guangdong Province, Guangzhou, 510630, China.
| | - Stefano Boriani
- GSpine4 Spine Surgery Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| |
Collapse
|
19
|
Pignataro L, Peri A, Pagani D, Iudica F, Scaramellini G. Cricoid Chondrosarcoma Coexisting with a Thyroid Mass: Case Report and Review of the Literature. TUMORI JOURNAL 2018; 92:257-9. [PMID: 16869248 DOI: 10.1177/030089160609200315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laryngeal chondrosarcomas are rare cartilaginous tumors that usually present with hoarseness, dyspnea and, occasionally, dysphagia and dysphonia. We report the case of a low-grade chondrosarcoma of the cricoid cartilage coexisting with a right thyroid nodule, which presented with homolateral vocal fold paralysis. After a precautionary tracheotomy the patient underwent a laryngofissure in which the mass arising from the posterior plate of the cricoid cartilage was entirely enucleated. The histopathological analysis was compatible with a low-grade chondrosarcoma involving the posterior resection margin. For this reason, in agreement with the patient's wishes, a total laryngectomy and simultaneous right hemithyroidectomy were performed. We here discuss the peculiarity of the presentation and the therapeutic dilemma posed by this rare neoplasm.
Collapse
Affiliation(s)
- Lorenzo Pignataro
- Department of Otorhinolaryngology and Ophthalmological Sciences, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy.
| | | | | | | | | |
Collapse
|
20
|
Davis EJ, Wu YM, Robinson D, Schuetze SM, Baker LH, Athanikar J, Cao X, Kunju LP, Chinnaiyan AM, Chugh R. Next generation sequencing of extraskeletal myxoid chondrosarcoma. Oncotarget 2017; 8:21770-21777. [PMID: 28423517 PMCID: PMC5400622 DOI: 10.18632/oncotarget.15568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/09/2017] [Indexed: 12/29/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is an indolent translocation-associated soft tissue sarcoma with a high propensity for metastases. Using a clinical sequencing approach, we genomically profiled patients with metastatic EMC to elucidate the molecular biology and identify potentially actionable mutations. We also evaluated potential predictive factors of benefit to sunitinib, a multi-targeted tyrosine kinase inhibitor with reported activity in a subset of EMC patients. Between January 31, 2012 and April 15, 2016, six patients with EMC participated in the clinical sequencing research study. High quality DNA and RNA was isolated and matched normal samples underwent comprehensive next generation sequencing (whole or OncoSeq capture exome of tumor and normal, tumor PolyA+ and capture transcriptome). The expression levels of sunitinib targeted-kinases were measured by transcriptome sequencing for KDR, PDGFRA/B, KIT, RET, FLT1, and FLT4. The previously reported EWSR1-NR4A3 translocation was identified in all patient tumors; however, other recurring genomic abnormalities were not detected. RET expression was significantly greater in patients with EMC relative to other types of sarcomas except for liposarcoma (p<0.0002). The folate receptor was overexpressed in two patients. Our study demonstrated that similar to other translocation-associated sarcomas, the mutational profile of metastatic EMC is limited beyond the pathognomonic translocation. The clinical significance of RET expression in EMC should be explored. Additional pre-clinical investigations of EMC may help elucidate molecular mechanisms contributing to EMC tumorigenesis that could be translated to the clinical setting.
Collapse
Affiliation(s)
- Elizabeth J Davis
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Dan Robinson
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Scott M Schuetze
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Laurence H Baker
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jyoti Athanikar
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Xuhong Cao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rashmi Chugh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
21
|
Kamal AF, Husodo K, Prabowo Y, Hutagalung EU. Correlation between survival and tumour characteristics in patients with chondrosarcoma. J Orthop Surg (Hong Kong) 2015; 23:365-9. [PMID: 26715720 DOI: 10.1177/230949901502300323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the correlation between survival and tumour characteristics in 23 patients with chondrosarcoma. METHODS Records of 15 men and 8 women aged 14 to 66 (mean, 37) years who were diagnosed with primary (n=19) or secondary (n=4) chondrosarcoma of the axial skeleton (n=8), proximal extremity (n=9), or distal extremity (n=6) were reviewed. The tumour diameter was <10 cm in 4 patients, 10-19 cm in 12, and 20-30 cm in 7. The tumour involved the intramedullary in 17 and the periosteum in 6 patients; tumour extension was intracompartmental in 5 and extracompartmental in 18 patients. The Evans histological grade for the tumours was grade 1 in 6 patients, grade 2 in 10, and grade 3 in 7. The mean tumour size was 12.3 cm for grade 1 tumours, 18.2 cm for grade 2 tumours, and 18.3 cm for grade 3 tumours. 13 patients had no metastasis and 3 of 10 patients with grade 2 tumours and all 7 patients with grade 3 tumours had metastasis to the lung at presentation. 17 patients underwent surgery, one underwent adjuvant treatment only, and 5 declined treatment. RESULTS The mean follow-up period for the 23 patients was 3.1 years (range, 3 weeks to 9 years). The 5-year survival rate was 43% overall, 83.3% for grade 1 tumours, 50% for grade 2 tumours, and 0% for grade 3 tumours. The median survival duration was 20 (95% confidence interval, 11-29) months. Two patients had local recurrence and 16 did not, and the 5 patients who declined treatment died. Survival correlated with Evans histological grading (p=0.004), the presence of metastasis at presentation (p=0.026) and local recurrence (p=0.004). CONCLUSION The survival rate was lower in patients with higher Evan grading, metastasis, or local recurrence.
Collapse
Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedic and Traumatology, Ciptomangunkusumo National Central Hospital / Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | | |
Collapse
|
22
|
Farhane FZ, Alami Z, Bouhafa T, Elmazghi A, Hassouni K. Paravertebral extraskeletal myxoid chondrosarcoma: a case report and review of the literature. Pan Afr Med J 2015; 21:213. [PMID: 26448808 PMCID: PMC4587080 DOI: 10.11604/pamj.2015.21.213.6639] [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: 03/21/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022] Open
Abstract
The extraskeletal myxoid chondrosarcoma (CME) is a rare malignant soft tissue tumour described as a distinct clinical, histological, immunohistochemical, genetical and evolutive entity. It represents only 2.5% of soft tissue sarcomas. Its individualization is important because it has a long and indolent clinical course, and tumour-related death often occurs after a long survival period. The diagnostic key is morphological supported by immunohistochemistry and genetics t (9; 22) that allow differentiating it from other tumours with myxoid stroma and from chordoma. This report describes a patient with paravertebral extraskeletal myxoid chondrosrcoma with a high locoregional extension.
Collapse
Affiliation(s)
| | - Zineb Alami
- Department of Radiotherapy, Hassan II University Hospital, Fez, Morocco
| | - Touria Bouhafa
- Department of Radiotherapy, Hassan II University Hospital, Fez, Morocco
| | | | - Khalid Hassouni
- Department of Radiotherapy, Hassan II University Hospital, Fez, Morocco
| |
Collapse
|
23
|
Villert A, Kolomiets L, Vasilyev N, Perelmuter V, Savenkova O. Extraskeletal myxoid chondrosarcoma of the vulva: A case report. Oncol Lett 2015; 10:2095-2099. [PMID: 26622802 PMCID: PMC4579798 DOI: 10.3892/ol.2015.3586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 01/07/2015] [Indexed: 01/11/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (ESMC) of the vulva is an extremely rare tumor and currently, there is little available information on its biological behavior and treatment strategy. The present study reports a case of recurrent ESMC of the vulva in a 32-year-old female. The patient presented with an increasingly painful mass of the right vulva, at the site of an exision which had been performed 7-months previously. The tumor mass was histopathologically diagnosed as primary ESMC of the vulva and subsequently, vulvectomy was performed. Cytological examination showed negative surgical margins. Intraoperative radiation therapy at a single dose of 10 Gy was administered to the bed of the removed tumor. The patient refused chemotherapy and five months after surgery, a new lesion was identified in the inguinal region. Bilateral inguinal-femoral lymph node dissection was performed and external beam radiation therapy at a dose of 40 Gy was administered to the inguinal region. Follow-up examination seven months after surgery revealed no evidence of disease progression and at present, the patient remains alive. This study highlights the importance of analyzing each clinical case of ESMC as this may lead to the development of guidelines for the optimal treatment of this rare tumor.
Collapse
Affiliation(s)
- Alisa Villert
- Department of Oncogynecology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Larisa Kolomiets
- Department of Oncogynecology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Nikolay Vasilyev
- Department of Clinical Pathology and Cytology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Vladimir Perelmuter
- Department of Clinical Pathology and Cytology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| | - Olga Savenkova
- Department of Clinical Pathology and Cytology, Cancer Research Institute, Siberian Branch of the Russian Academy of Medical Sciences, Tomsk, Russia
| |
Collapse
|
24
|
Stacchiotti S, Pantaleo MA, Astolfi A, Dagrada GP, Negri T, Dei Tos AP, Indio V, Morosi C, Gronchi A, Colombo C, Conca E, Toffolatti L, Tazzari M, Crippa F, Maestro R, Pilotti S, Casali PG. Activity of sunitinib in extraskeletal myxoid chondrosarcoma. Eur J Cancer 2014; 50:1657-64. [PMID: 24703573 DOI: 10.1016/j.ejca.2014.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma, marked by NR4A3 rearrangement. Herein we report on the activity of sunitinib in a series of 10 patients, strengthening what initially observed in two cases. PATIENTS AND METHODS From July 2011, 10 patients with progressive metastatic translocated EMC have been consecutively treated with sunitinib 37.5mg/day, on a named-use basis. In an attempt to interpret the activity of sunitinib in EMC, genotype/phenotype correlations were carried out by fluorescence in situ hybridization (FISH) analyses. Moreover, transcriptome, immunohistochemical and biochemical analyses of a limited set of samples were performed focusing on some putative targets of sunitinib. RESULTS Eight of 10 patients are still on therapy. Six patients had a Response Evaluation Criteria in Solid Tumours (RECIST) partial response (PR), two were stable, two progressed. Positron emission tomography (PET) was consistent in 6/6 evaluable cases. One patient underwent surgery after sunitinib, with evidence of a pathologic response. At a median follow-up of 8.5 months (range 2-28), no secondary resistance was detected. Median progression free survival (PFS) has not been reached. Interestingly, all responsive cases turned out to express the typical EWSR1-NR4A3 fusion, while refractory cases carried the alternative TAF15-NR4A3 fusion. Among putative sunitinib targets, only RET was expressed and activated in analysed samples. CONCLUSIONS This report confirms the therapeutic activity of sunitinib in EMC. Genotype/phenotype analyses support a correlation between response and EWSR1-NR4A3 fusion. Involvement of RET deserves further investigation.
Collapse
Affiliation(s)
- S Stacchiotti
- Adult Mesenchymal Tumor Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - M A Pantaleo
- Dipartimento di Medicina Sperimentale, Specialistica e Diagnostica, Università di Bologna, Bologna, Italy
| | - A Astolfi
- Centro Interdipartimentale di Ricerche sul Cancro "G. Prodi", Università di Bologna, Bologna, Italy
| | - G P Dagrada
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - T Negri
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A P Dei Tos
- Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy
| | - V Indio
- Centro Interdipartimentale di Ricerche sul Cancro "G. Prodi", Università di Bologna, Bologna, Italy
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - E Conca
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - L Toffolatti
- Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy
| | - M Tazzari
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - F Crippa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R Maestro
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - S Pilotti
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - P G Casali
- Adult Mesenchymal Tumor Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
25
|
Stacchiotti S, Dagrada GP, Sanfilippo R, Negri T, Vittimberga I, Ferrari S, Grosso F, Apice G, Tricomi M, Colombo C, Gronchi A, Dei Tos AP, Pilotti S, Casali PG. Anthracycline-based chemotherapy in extraskeletal myxoid chondrosarcoma: a retrospective study. Clin Sarcoma Res 2013; 3:16. [PMID: 24345066 PMCID: PMC3879193 DOI: 10.1186/2045-3329-3-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/13/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare subgroup within soft tissue sarcomas. Its sensitivity to chemotherapy is reported to be low. METHODS We retrospectively reviewed a series of 11 EMC patients treated as from 2001 within the Italian Rare Cancer Network (RCN) with anthracycline-based chemotherapy. Pathologic diagnosis was centrally reviewed in all cases and confirmed by the presence of the specific chromosomal rearrangements, involving the NR4A3 gene locus on chromosome 9. RESULTS Eleven patients treated with anthracycline-based chemotherapy were included (M/F: 9/2 - mean age: 52 years - site of primary: lower limb/other = 9/2 - metastatic = 11 - front line/ further line = 10/1 - anthracycline as single agent/ combined with ifosfamide = 1/10). Ten patients are evaluable for response. Overall, best response according to RECIST was: partial response (PR) = 4 (40 %), stable disease (SD) = 3, progressive disease (PD) = 3 cases. Median PFS was 8 (range 2-10) months. CONCLUSIONS By contrast to what reported so far, anthracycline-based chemotherapy is active in a distinct proportion of EMC patients.
Collapse
Affiliation(s)
- Silvia Stacchiotti
- Adult Mesenchymal Tumor Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Extraskeletal myxoid chondrosarcoma with small bowel metastasis causing bowel obstruction. Case Rep Oncol Med 2012; 2012:621025. [PMID: 23213584 PMCID: PMC3506900 DOI: 10.1155/2012/621025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/21/2012] [Indexed: 11/17/2022] Open
Abstract
A 28-year-old female with history of chest wall extraskeletal myxoid chondrosarcoma (EMC) presented to the emergency department complaining of two weeks of lightheadedness and fatigue. Laboratories showed hemoglobin of 7.6 g/dL and a positive hemoccult test. Upper and lower endoscopies were unremarkable, and the patient was discharged after blood transfusion. The next day she returned to the ED with left-sided weakness and perioral numbness. Brain CT scan revealed a 6 cm right frontal mass with midline shift and edema that required urgent craniotomy with resection of a hemorrhagic tumor. The patient continued dropping her hemoglobin, and CT scans showed a rounded 3 cm small bowel mass in the mid ileum. Repeat upper endoscopy revealed a 2 × 2 cm ulcerated mass in the fourth portion of the duodenum. The patient was taken to the operating room and was found to have two lesions; one in the distal duodenum and a second one in the mid ileum causing small bowel intussusception. Pathology was consistent with metastatic EMC grade 2/3, involving the bowel and mesenteric fat. Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma with unique features that distinguishes, it from other sarcomas. It has been often described as a low-grade sarcoma although there are certain characteristics like high mitotic activity and the presence of focal regions of Ki67 staining above 25% that correlate with aggressive behavior of the tumor. This is the first case of EMC metastatic to the small bowel to be reported to the medical community.
Collapse
|
27
|
Stacchiotti S, Dagrada GP, Morosi C, Negri T, Romanini A, Pilotti S, Gronchi A, Casali PG. Extraskeletal myxoid chondrosarcoma: tumor response to sunitinib. Clin Sarcoma Res 2012; 2:22. [PMID: 23058004 PMCID: PMC3534218 DOI: 10.1186/2045-3329-2-22] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/30/2012] [Indexed: 01/26/2023] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMCS) is a rare soft tissue sarcoma of uncertain differentiation, characterized in most cases by a translocation that results in the fusion protein EWSR1-CHN (the latter even called NR4A3 or TEC). EMCS is marked by >40% incidence of metastases in spite of its indolent behaviour. It is generally resistant to conventional chemotherapy, and, to the best of our knowledge, no data have been reported to date about the activity of tirosin-kinase inhibitor (TKI) in this tumor. We report on two consecutive patients carrying an advanced EMCS treated with sunitinib. Methods Since July 2011, 2 patients with progressive pretreated metastatic EMCS (Patient1: woman, 58 years, PS1; Patient2: man, 63 years, PS1) have been treated with continuous SM 37.5 mg/day, on an individual use basis. Both patients are evaluable for response. In both cases diagnosis was confirmed by the presence of the typical EWSR1-CHN translocation. Results Both patients are still on treatment (11 and 8 months). Patient 1 got a RECIST response after 4 months from starting sunitinib, together with a complete response by PET. An interval progression was observed after stopping sunitinib for toxicity (abscess around previous femoral fixation), but response was restored after restarting sunitinib. Patient 2 had an initial tumor disease stabilization detected by CT scan at 3 months. Sunitinib was increased to 50 mg/day, with evidence of a dimensional response 3 months later. Conclusions Sunitinib showed antitumor activity in 2 patients with advanced EMCS. Further studies are needed to confirm these preliminary results.
Collapse
Affiliation(s)
- Silvia Stacchiotti
- Department of Cancer Medicine, Adult Sarcoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori Milan, via Venezian 1, 20133, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Ogura K, Fujiwara T, Beppu Y, Chuman H, Yoshida A, Kawano H, Kawai A. Extraskeletal myxoid chondrosarcoma: a review of 23 patients treated at a single referral center with long-term follow-up. Arch Orthop Trauma Surg 2012; 132:1379-86. [PMID: 22678528 DOI: 10.1007/s00402-012-1557-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. Although it has been regarded as a low-grade sarcoma unassociated with tumor-related death, a recent study has suggested an insidious nature with a high propensity for relapse during a long disease course. The aim of this study was to clarify the long-term clinical features of EMC treated at a single referral center using state-of-the-art techniques. METHODS A retrospective review of 23 consecutive patients (10 males, 13 females; mean age 58 years) treated between 1979 and 2008 (mean follow-up; 109 months) was performed. RESULTS Surgery for the primary tumor was performed in 22 patients, and 7 cases recurred locally due to inadequate resection. Eleven patients had metastatic disease, either at diagnosis (3) or developing later (8). The 5/10-year overall survival rates were 91/84 %, and the 5/10-year local recurrence-free and metastasis-free survival rates for patients with localized disease were 89/62 and 89/61 %, respectively. Larger tumor size (>10 cm) and metastases at diagnosis were significant negative prognostic factors. Four patients received ifosfamide-based chemotherapy with no objective response. There was no local recurrence in three patients who underwent R1 resection followed by adjuvant radiotherapy. Clinical palliation and retarded progression of the metastatic disease were achieved in three patients who underwent radiotherapy. CONCLUSIONS EMC is indolent but has a high propensity for relapse over 5 years of follow-up. Definitive initial surgery and careful monitoring for a prolonged period are important. Radiotherapy seems beneficial in an adjuvant setting and as palliative therapy for metastatic disease.
Collapse
Affiliation(s)
- Koichi Ogura
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | | | | | | | | | | | | |
Collapse
|
29
|
Boyd AS. Chromosomal translocation-negative cellular extraskeletal myxoid chondrosarcoma in an adolescent female. J Cutan Pathol 2012; 39:872-6. [DOI: 10.1111/j.1600-0560.2012.01943.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 10/19/2011] [Accepted: 02/25/2012] [Indexed: 02/06/2023]
|
30
|
|
31
|
Abstract
Soft-tissue sarcomas are rare diseases with >50 subtypes. Surgery is the most important treatment in localized disease, sometimes combined with radiotherapy. Chemotherapy is used as palliation in advanced disease, sometimes also with a potential to decrease tumour size and eradicate micro-metastases, making meaningful surgery possible. The role of chemotherapy as adjuvant treatment in localized disease is not finally settled. Doxorubicin and ifosfamide are the two drugs with the best established response rates in soft-tissue sarcoma, and a combination of these drugs has been a 'gold standard' for several years. However, there is an emerging knowledge of the biology and sensitivity to treatment for different histological subtypes. New drugs such as gemcitabine, taxanes and trabectedin have been explored in several studies, showing promising results. Even if most studies have encompassed many different subtypes and were limited in size, knowledge related to specific treatment for different subtypes is emerging. Examples are trabectedin in lyposarcoma and leiomyosarcoma, and taxanes in angiosarcoma.
Collapse
Affiliation(s)
- M Eriksson
- Department of Oncology, Lund University and Skånes University Hospital, Lund, Sweden.
| |
Collapse
|
32
|
Mitchell AP, Poiesz M, Leung A. A case of highly aggressive extraskeletal myxoid chondrosarcoma. Case Rep Oncol 2011; 4:377-84. [PMID: 21941486 PMCID: PMC3177793 DOI: 10.1159/000331237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a soft tissue malignancy characterized by specific chromosomal abnormalities involving the TEC gene. This disease has historically been considered largely indolent both histologically and clinically. Rarer subsets of EMC exist that demonstrate aggressive histopathologic features and clinical behavior, though it remains unclear whether or not aggressive histopathology is predictive of outcome. Herein we present a case of EMC with aggressive histopathologic features that underwent rapid clinical progression despite initial treatment with curative intent. This case provides the context for a discussion of the existing literature regarding treatment, prognosis, pathology, and genetic/molecular features of EMC in general and aggressive EMC specifically.
Collapse
Affiliation(s)
- Aaron P Mitchell
- Duke University Medical Center, Internal Medicine Residency Program, Durham, N.C., USA
| | | | | |
Collapse
|
33
|
Bumpass DB, Kyriakos M, Rubin DA, Manske PR, Goldfarb CA. Myxoid chondrosarcoma of the phalanx with an EWS translocation: a case report and review of the literature. J Bone Joint Surg Am 2011; 93:e23. [PMID: 21411698 DOI: 10.2106/jbjs.j.00520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David B Bumpass
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | | | | | |
Collapse
|
34
|
|
35
|
Han K, Sun YJ, Shen Z, Zhang JJ, Lin F, Zhao H, Meerani S, Yao Y. Extraskeletal myxoid chondrosarcoma: a case report of complete remission by chemotherapy and review of the literature. BMJ Case Rep 2010; 2010:bcr07.2009.2128. [PMID: 22315646 DOI: 10.1136/bcr.07.2009.2128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma is a rare soft tissue sarcoma. Surgery is the cornerstone of the management of this tumour. The response rate to chemotherapy has been very poor; with the exception of one reported case which showed promising results, overall results are disappointing because no significant radiologic or clinical responses have been noted with chemotherapy. Here we report the case of a 15-year-old girl who presented with extraskeletal myxoid chondrosarcoma in the sacrococcygeal region which was regarded as unresectable. After four cycles of chemotherapy the mass showed complete remission which has lasted >6 months.
Collapse
Affiliation(s)
- Kun Han
- Medical Oncology Department, Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University, Yi Shan Road No.600, XuHui District, Shanghai China
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Drilon AD, Popat S, Bhuchar G, D'Adamo DR, Keohan ML, Fisher C, Antonescu CR, Singer S, Brennan MF, Judson I, Maki RG. Extraskeletal myxoid chondrosarcoma: a retrospective review from 2 referral centers emphasizing long-term outcomes with surgery and chemotherapy. Cancer 2009; 113:3364-71. [PMID: 18951519 DOI: 10.1002/cncr.23978] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a genetically distinct sarcoma with a propensity for local recurrence and metastasis despite an indolent course. To the authors' knowledge, there are limited data examining chemotherapy outcomes as a guide to therapeutic decisions for unresectable disease. METHODS The clinical behavior and treatment responses of 87 patients with EMC who were seen at 2 institutions between 1975 and 2008 were examined. RESULTS The median age of the patients at the time of diagnosis was 49.5 years, with a male-to-female ratio of 2:1. For patients presenting without metastases, 37% developed local recurrence (median time of 3.3 years) and 26% developed distal recurrence (median time of 3.2 years). Approximately 13% of patients presented with metastases. The 5-year, 10-year, and 15-year overall survival rates were 82%, 65%, and 58%, respectively. Twenty-one patients received 32 evaluable courses of chemotherapy. No significant radiologic or clinical responses were noted. The median time to disease progression while receiving chemotherapy was 5.2 months. The best physician-assessed response to chemotherapy was stable disease for at least 6 months in 25% of patients, stable disease for <6 months in 41% of patients, and disease progression in 34% of patients. The estimated progression-free survival rates at 3 months, 4 months, 6 months, and 9 months were 69%, 65%, 40%, and 26%, respectively. CONCLUSIONS This retrospective review highlights the poor response rate to chemotherapy and emphasizes aggressive control of localized disease as the primary approach to management. Although there are biases inherent in retrospective analyses, these data provide a benchmark for time to disease progression for the study of new agents for the treatment of patients with this diagnosis.
Collapse
Affiliation(s)
- Alex D Drilon
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Malignant Melanoma in the 21st Century, Part 1: Epidemiology, Risk Factors, Screening, Prevention, and Diagnosis. Mayo Clin Proc 2007. [PMID: 17352373 DOI: 10.1016/s0025-6196(11)61033-1] [Citation(s) in RCA: 267] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
38
|
Markovic SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, Vachon CM, Schild SE, McWilliams RR, Hand JL, Laman SD, Kottschade LA, Maples WJ, Pittelkow MR, Pulido JS, Cameron JD, Creagan ET. Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc 2007; 82:364-80. [PMID: 17352373 DOI: 10.4065/82.3.364] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Malignant melanoma is an aggressive, therapy-resistant malignancy of melanocytes. The incidence of melanoma has been steadily increasing worldwide, resulting in an increasing public health problem. Exposure to solar UV radiation, fair skin, dysplastic nevi syndrome, and a family history of melanoma are major risk factors for melanoma development. The interactions between genetic and environmental risk factors that promote melanomagenesis are currently the subject of ongoing research. Avoidance of UV radiation and surveillance of high-risk patients have the potential to reduce the population burden of melanoma. Biopsies of the primary tumor and sampling of draining lymph nodes are required for optimal diagnosis and staging. Several clinically relevant pathologic subtypes have been identified and need to be recognized. Therapy for early disease is predominantly surgical, with a minor benefit noted with the use of adjuvant therapy. Management of systemic melanoma is a challenge because of a paucity of active treatment modalities. In the first part of this 2-part review, we discuss epidemiology, risk factors, screening, prevention, and diagnosis of malignant melanoma. Part 2 (which will appear in the April 2007 issue) will review melanoma staging, prognosis, and treatment.
Collapse
Affiliation(s)
- Svetomir N Markovic
- Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
A potential diagnostic pitfall in the histologic assessment of melanoma is the inability to recognize unusual melanoma variants. Of these, the more treacherous examples include the desmoplastic melanoma, the nevoid melanoma, the so-called 'minimal-deviation melanoma,' melanoma with prominent pigment synthesis or 'animal-type melanoma,' and the malignant blue nevus. Also problematic are the unusual phenotypic profiles seen in vertical growth phase melanomas; these include those tumors whose morphological peculiarities mimic cancers of nonmelanocytic lineage and those melanomas that express aberrant antigenic profiles not commonly associated with a melanocytic histogenesis. Metaplastic change in melanoma, balloon cell melanoma, signet-ring cell melanoma, myxoid melanoma, small cell melanoma and rhabdoid melanoma all have the potential to mimic metastatic and primary neoplasms of different lineage derivations. Abnormal immunohistochemical expression of CD 34, cytokeratins, epithelial membrane antigen, and smooth muscle markers as well as the deficient expression of S100 protein and melanocyte lineage-specific markers such as GP100 protein (ie HMB-45 antibody) and A103 (ie Melan-A) also present confusing diagnostic challenges. In this review, we will discuss in some detail certain of these novel clinicopathologic types of melanoma, as well as the abnormal phenotypic expressions seen in vertical growth phase melanoma.
Collapse
Affiliation(s)
- Cynthia M Magro
- Division of Dermatopathology, Department of Pathology, Ohio State University, Columbus, OH 43215, USA.
| | | | | |
Collapse
|
40
|
Saint-Blancard P, Jancovici R, Ceccaldi B, Lagace R, Sastre-Garau X. [Extraskeletal myxoid chondrosarcoma of the neck: report of a case with lymph nodes metastasis]. Rev Med Interne 2005; 27:160-2. [PMID: 16337717 DOI: 10.1016/j.revmed.2005.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 09/21/2005] [Indexed: 01/15/2023]
|
41
|
Hisaoka M, Hashimoto H. Extraskeletal myxoid chondrosarcoma: updated clinicopathological and molecular genetic characteristics. Pathol Int 2005; 55:453-63. [PMID: 15998372 DOI: 10.1111/j.1440-1827.2005.01853.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma characterized by distinctive morphological and cytogenetical features. As its name implies, EMC was believed to represent a variant of soft-tissue chondrosarcoma owing to its histological resemblance to chondroblastic tissue in the early stages of cartilage development or chondroid tumors such as skeletal chondrosarcoma. However, the chondroid nature has been a subject of controversy, and its line of differentiation remains to be determined. Consequently, the tumor is provisionally classified into a group of tumors of uncertain differentiation in the revised World Health Organization classification of tumors of soft tissue and bone. Moreover, immunohistochemical and ultrastructural features of neural or neuroendocrine differentiation have been recently reported in a subset of EMC, providing a new insight into their histogenetic nature. Chromosomal rearrangements involving 9q22, such as t(9;22)(q22;q12), and resultant NR4A3 fusion genes are tumor-type specific or pathognomotic for this entity and are assumed to play an important role in the development of EMC. Although the biological mechanisms and functions are largely unknown, the NR4A3-related pathway is considered a potential molecular target for future therapeutic intervention. Because of its protracted but resilient nature, a tenacious and long-term follow up is necessary for any patient.
Collapse
Affiliation(s)
- Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | | |
Collapse
|
42
|
Aksoy S, Abali H, Kiliçkap S, Güler N. Successful treatment of a chemoresistant tumor with temozolomide in an adult patient: report of a recurrent intracranial mesenchymal chondrosarcoma. J Neurooncol 2005; 71:333-4. [PMID: 15735926 DOI: 10.1007/s11060-004-1725-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
43
|
Fotiadis C, Charalambopoulos A, Chatzikokolis S, Zografos GC, Genetzakis M, Tringidou R. Extraskeletal myxoid chondrosarcoma metastatic to the pancreas: a case report. World J Gastroenterol 2005; 11:2203-5. [PMID: 15810095 PMCID: PMC4305798 DOI: 10.3748/wjg.v11.i14.2203] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2004] [Revised: 10/24/2004] [Accepted: 11/29/2004] [Indexed: 02/06/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a low-grade sarcoma characterized by developing metastases and local recurrence in high rate. It is mainly deep seated in the proximal extremities. The most common metastatic sites are the lungs, soft tissues, lymph nodes, bones and the brain. To our knowledge, no case of clearly defined EMC has been reported to date developing a metastasis in the pancreas. We describe a case of a man suffering from EMC who developed a single pancreatic metastasis 20 years after the initial diagnosis. A 49-year-old man was submitted to surgical excision of an EMC, in left thigh, 20 years ago. Fourteen years after the initial diagnosis a local recurrence in left thigh occurred. Multiple lesions of metastatic origin, in both lungs, were excised via thoracotomies until the time being. In 2003, as a part of a periodically performed imaging control, an abdominal CT scan was performed revealing a solid lesion in the pancreas. Distal pancreatectomy was performed. The histopathology of the excised specimen proved to be the one of metastatic lesion of EMC. The above-mentioned case of EMC is, as far as we know, the first one described developing a certain pancreatic metastasis.
Collapse
Affiliation(s)
- C Fotiadis
- Third University Department of General Surgery, Athens School of Medicine, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
44
|
Schneiderbauer MM, Blanchard C, Gullerud R, Harmsen WS, Rock MG, Shives TC, Sim FH, Scully SP. Scapular chondrosarcomas have high rates of local recurrence and metastasis. Clin Orthop Relat Res 2004:232-8. [PMID: 15346079 DOI: 10.1097/01.blo.0000136905.44818.65] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This is the first report of a large series of patients with scapular chondrosarcomas. The grade distributions, locations of the tumors in the scapula, surgical techniques, status of margins, chondrosarcoma subtypes, Enneking stages, adjuvant therapies, local recurrence rates, metastasis rates, and survival prognoses of patients with scapular chondrosarcoma were evaluated. Forty-seven patients treated between 1921 and 1999 were analyzed retrospectively. Grade 3 disease was significantly associated with a poorer survival prognosis when compared with Grades 1 or 2 disease. Patients with tumors smaller than 5 cm were treated mainly with partial scapulectomy, and patients with tumors larger than 5 cm often were treated with total scapulectomy. The survival prognoses of patients with intralesional resections at initial surgery showed a tendency toward poorer survival when compared with patients with wide resections at initial surgery. Metastasis and local recurrence (21.3% and 40.4%) were higher in scapular chondrosarcomas than rates reported for patients with general chondrosarcomas, and local recurrence or metastasis was associated with limited survival. The 5- and 15-year survival probabilities subsequent to diagnosis were 79% and 53%, respectively. The high rates of local recurrence and metastasis likely were caused by the difficult anatomic relationships encountered during scapular resections. This study shows the importance of wide margins which must be achieved to provide local disease control.
Collapse
|
45
|
Gaudier F, Khurana JS, Dewan S, Shen T. Fine-needle aspiration cytology of intra-abdominal wall extraskeletal myxoid chondrosarcoma: a case report and review of the literature. Arch Pathol Lab Med 2003; 127:1211-3. [PMID: 12946219 DOI: 10.5858/2003-127-1211-facoiw] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumor. Most of the reported cases that were diagnosed by fine-needle aspiration were taken from the extremities, where the tumor is often found. Problems can occur when the site is unusual and cellular differentiation is not distinct. We present a case in which the tumor was located in the intra-abdominal wall, an unusual location. Cytologic features and immunocytochemistry are helpful in distinguishing this tumor from others that share similar myxoid background.
Collapse
Affiliation(s)
- Farah Gaudier
- Department of Pathology and Laboratory Medicine, Temple University Health System, Philadelphia, Pa, USA
| | | | | | | |
Collapse
|
46
|
Aquino VM, Tomlinson G, Weinberg AG, Eshelman DA. Extraskeletal myxoid chondrosarcoma as a second malignancy after bone marrow transplantation. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:336-7. [PMID: 12652628 DOI: 10.1002/mpo.10199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
47
|
Kawaguchi S, Wada T, Nagoya S, Ikeda T, Isu K, Yamashiro K, Kawai A, Ishii T, Araki N, Myoui A, Matsumoto S, Umeda T, Yoshikawa H, Hasegawa T. Extraskeletal myxoid chondrosarcoma: a Multi-Institutional Study of 42 Cases in Japan. Cancer 2003; 97:1285-92. [PMID: 12599237 DOI: 10.1002/cncr.11162] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant neoplasm. Despite a consensus for the distinct clinicopathologic entity of EMC, its clinical features remain controversial. In addition, most studies have contained a small number of patients who underwent definitive surgical treatment. METHODS Forty-two cases of EMC, which had been identified from files of eight affiliated hospitals and confirmed for histologic diagnosis at the Pathology Center, were analyzed for histologic grade, demographics, treatments, outcomes, and prognostic factors. The average follow-up period was 7.4 years. RESULTS Included in the study were 20 men and 22 women with a mean age at diagnosis of 52.1 years. The tumors were located mainly in the lower extremities (69%). Thirty-three tumors (79%) were classified as Grade 1 and nine as Grade 2 according to the modified French System. Overall survival was 100% at 5 years and 88% at 10 years. Disease-free survival was 45% at 5 years and 36% at 10 years. Inadequate initial surgery was defined as a significant risk factor for local recurrence by univariate analysis of all 42 patients but not by the analysis of those 30 patients who had undergone wide tumor excision or amputation. Wide excision led to the recurrence rate of 14%. CONCLUSIONS These findings supported the role of wide excision in the local control of EMC, irrespective of the previous excision procedure or recurrence. The protracted clinical course of the tumors and the presence of patients who had distant metastasis develop after definitive surgery of the primary tumor represented EMC as intermediate malignancy.
Collapse
Affiliation(s)
- Satoshi Kawaguchi
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Goh YW, Spagnolo DV, Platten M, Caterina P, Fisher C, Oliveira AM, Nascimento AG. Extraskeletal myxoid chondrosarcoma: a light microscopic, immunohistochemical, ultrastructural and immuno-ultrastructural study indicating neuroendocrine differentiation. Histopathology 2001; 39:514-24. [PMID: 11737310 DOI: 10.1046/j.1365-2559.2001.01277.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS Extraskeletal myxoid chondrosarcoma is a rare low-grade soft-tissue sarcoma with locally aggressive and metastasizing potential. Extraskeletal myxoid chondrosarcoma has distinctive clinical, light microscopic, immunophenotypic, cytogenetic and ultrastructural features. Evidence that extraskeletal myxoid chondrosarcoma often shows neuroendocrine features was first provided by Chhieng et al. on the basis of an immunohistochemical and ultrastructural study of seven cases. Our study aims to further confirm by immunohistochemistry and ultrastructural studies, including immunoelectron microscopy, that extraskeletal myxoid chondrosarcoma indeed may show neuroendocrine differentiation. METHODS AND RESULTS Fifteen cases of extraskeletal myxoid chondrosarcoma and seven control cases of skeletal chondrosarcomas were studied. Extensive immunohistochemical analysis was performed in all cases and ultrastructural studies were done in 11 extraskeletal myxoid chondrosarcomas and three skeletal chondrosarcomas. Immunoelectron microscopy was performed on one case each of extraskeletal myxoid chondrosarcoma and skeletal chondrosarcoma. Extraskeletal myxoid chondrosarcomas expressed neuron-specific enolase (100%), synaptophysin (87%), S100 (50%), PGP 9.5 (40%), and epithelial membrane antigen (25%). Co-expression of synaptophysin and PGP 9.5 was observed in six tumours. Skeletal chondrosarcomas showed expression of S100 protein, vimentin and neuron-specific enolase in all cases. Synaptophysin, chromogranin and PGP 9.5 were not expressed in any skeletal chondrosarcoma case. Ultrastructurally, extraskeletal myxoid chondrosarcoma was characterized by distinct cords of cells immersed in a glycosaminoglycan-rich matrix. The cells were rich in mitochondria, had well-developed Golgi apparatus and there were numerous smooth vesicles. In three cases there were easily found 140-180 nm diameter membrane-bound dense-core granules in cell bodies and in processes, unrelated to the Golgi, compatible with neurosecretory granules. Fewer such granules were present in the remaining extraskeletal myxoid chondrosarcoma cases, three of which also contained intracisternal tubules typical of extraskeletal myxoid chondrosarcoma. The skeletal chondrosarcomas had scalloped cell surfaces, prominent rough endoplasmic reticulum focally distended with secretory product, and lacked neurosecretory granules. Intermediate filaments were prominent in both extraskeletal myxoid chondrosarcoma and skeletal chondrosarcomas. Immunoelectron microscopy showed synaptophysin expression in the extraskeletal myxoid chondrosarcoma but not in the skeletal chondrosarcoma case. CONCLUSIONS This study confirms that a substantial proportion of extraskeletal myxoid chondrosarcomas show immunophenotypic and/or ultrastructural evidence of neuroendocrine differentiation, and are unlikely to be related to conventional skeletal chondrosarcomas.
Collapse
Affiliation(s)
- Y W Goh
- Department of Anatomical Pathology, The Western Australian Centre for Pathology and Medical Research (PathCentre), Nedlands, Western Australia
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Chondrosarcoma is the second most common malignant bone tumor and is relatively unresponsive to chemotherapy and radiation regimens. In addition, the clinical course of chondrosarcoma is difficult to predict. The purpose of this study was to review the authors' experience with chondrosarcoma and ascertain any factors related to prognosis and clinical outcome. The medical records of 108 patients followed up for a minimum of 2 years were retrospectively reviewed. There were 31 low-grade and 77 high-grade chondrosarcomas. One hundred one patients underwent surgical resection. There was a statistically significant association between positive margins and local recurrence, metastasis, and death. Tumor grade was not predictive of outcome. Proliferation indices (MIB-1 expression determination through immunohistochemistry) were quantitated in 39 patients. A significant association was seen between MIB-1 expression and recurrence and death. Thus, objective quantitation of tumor proliferation was more predictive than was histologic grade of outcome in chondrosarcoma. Although histologic grade continues to be the standard grading system for chondrosarcoma, the current study contributes to ongoing research and validation of alternative techniques that may be more reliable in guiding prognosis and treatment of chondrosarcoma.
Collapse
|
50
|
Takeda A, Tsuchiya H, Mori Y, Nonomura A, Tomita K. Extraskeletal myxoid chondrosarcoma with multiple skeletal metastases. J Orthop Sci 2001; 5:171-4. [PMID: 10982652 DOI: 10.1007/s007760050145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pulmonary metastases are not unusual in extraskeletal myxoid chondrosarcoma; however, only two patients have been reported with multiple bony metastases. We report here one patient with extraskeletal myxoid chondrosarcoma associated with lung and multiple bony metastases. After chemotherapy, the primary lesion was resected, but lung and multiple bony metastases were found 20 months later. The bony metastases were in the right femur, right humerus, and at multiple vertebral levels. Because of a pathologic fracture of the right femur, the metastases in the right femur and right humerus were surgically stabilized. After chemotherapy, the lung metastases were resected, and those in the vertebral bodies were treated with radiotherapy.
Collapse
Affiliation(s)
- A Takeda
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | | | | | | | | |
Collapse
|