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Pinto FFE, Mello CAL, Nakagawa SA, Chung WT, Torrezan GT, Barros BDF, Cunha IW, Calsavara VF, Carraro DM, Lopes A. Does the Addition of Mutations of CTNNB1 S45F to Clinical Factors Allow Prediction of Local Recurrence in Patients With a Desmoid Tumor? A Local Recurrence Risk Model. Clin Orthop Relat Res 2023; 481:1978-1989. [PMID: 37104792 PMCID: PMC10499079 DOI: 10.1097/corr.0000000000002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/16/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The initial approach to the treatment of desmoid tumors has changed from surgical resection to watchful waiting. However, surgery is still sometimes considered for some patients, and it is likely that a few patients would benefit from tumor removal if the likelihood of local recurrence could be predicted. However, to our knowledge, there is no tool that can provide guidance on this for clinicians at the point of care. QUESTION/PURPOSE We sought to explore whether a combined molecular and clinical prognostic model for relapse in patients with desmoid tumors treated with surgery would allow us to identify patients who might do well with surgical excision. METHODS This was a retrospective, single-center study of 107 patients with desmoid tumors who were surgically treated between January 1980 and December 2015, with a median follow-up of 106 months (range 7 to 337 months). We correlated clinical variables (age, tumor size, and localization) and CTNNB1 gene mutations with recurrence-free survival. Recurrence-free survival was estimated using a Kaplan-Meier curve. Univariate and multivariable analyses of time to local recurrence were performed using Cox regression models. A final nomogram model was constructed according to the final fitted Cox model. The predictive performance of the model was evaluated using measures of calibration and discrimination: calibration plot and the Harrell C-statistic, also known as the concordance index, in which values near 0.5 represent a random prediction and values near 1 represent the best model predictions. RESULTS The multivariable analysis showed that S45F mutations (hazard ratio 5.25 [95% confidence interval 2.27 to 12.15]; p < 0.001) and tumor in the extremities (HR 3.15 [95% CI 1.35 to 7.33]; p = 0.008) were associated with a higher risk of local recurrence. Based on these risk factors, we created a model; we observed that patients considered to be at high risk of local recurrence as defined by having one or two factors associated with recurrence (extremity tumors and S45F mutation) had an HR of 8.4 compared with patients who had no such factors (95% CI 2.84 to 24.6; p < 0.001). From these data and based on the multivariable Cox models, we also developed a nomogram to estimate the individual risk of relapse after surgical resection. The model had a concordance index of 0.75, or moderate discrimination. CONCLUSION CTNNB1 S45F mutations combined with other clinical variables are a potential prognostic biomarker associated with the risk of relapse in patients with desmoid tumors. The developed nomogram is simple to use and, if validated, could be incorporated into clinical practice to identify patients at high risk of relapse among patients opting for surgical excision and thus help clinicians and patients in decision-making. A large multicenter study is necessary to validate our model and explore its applicability. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Fabio F. E. Pinto
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Celso A. L. Mello
- Department of Clinical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Suely A. Nakagawa
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Wu Tu Chung
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Giovana T. Torrezan
- Clinical and Functional Genomics Group, International Research Center/CIPE, A. C. Camargo Cancer Center, São Paulo, Brazil
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation, São Paulo, Brazil
| | - Bruna D. F. Barros
- Clinical and Functional Genomics Group, International Research Center/CIPE, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Isabela W. Cunha
- Department of Anatomic Pathology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Vinícius F. Calsavara
- Cedars Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Dirce M. Carraro
- Clinical and Functional Genomics Group, International Research Center/CIPE, A. C. Camargo Cancer Center, São Paulo, Brazil
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation, São Paulo, Brazil
| | - Ademar Lopes
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
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Meade A, Wisecarver I, Cho MJ, Davis JJ, Duque S, Farewell JT, Zhang AY. The Role of Reconstruction on Desmoid Tumor Recurrence: A Systematic Review and Technical Considerations. Ann Plast Surg 2023; 90:S195-S202. [PMID: 36729103 DOI: 10.1097/sap.0000000000003381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Desmoid tumors occur throughout the body, presenting as aggressive, locally invasive lesions that can impede quality of life. Many controversies remain regarding the optimal surgical treatment of desmoid. This article presents a systematic review and meta-analysis on surgical management, focusing on risk of recurrence and the utility of reconstruction within this unique patient population. METHODS A systematic review was conducted to search for articles. The clinical course of patients diagnosed with desmoid tumors and treated by our institution's multidisciplinary team was retrospectively reviewed over a 13-year period. Meta-analysis study findings were compared with our cohort. RESULTS From the systematic review, 10 studies with level of evidence III were found, which resulted in 981 patients. Twenty patients from our institution met the inclusion criteria for our study. In both our study cohort and the pooled results, recurrence was significantly higher in patients with positive microscopic margin after resection. In our study cohort, patients with recurrence had higher rates of positive margins compared with those without recurrence (83.3% vs 7.1%, P = 0.004), whereas the pooled study showed a difference of margin positivity of 50% vs 40% ( P = 0.01). No patients who underwent reconstruction in our study cohort had a recurrence during the study period. CONCLUSION In both our cohort and pooled results, recurrence was significantly higher in patients with positive margins after initial resection. Reconstruction was not found to be a risk factor for recurrence. Reconstruction following desmoid tumor resection should be considered a viable option if a large and aggressive resection is required to obtain negative margins.
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Affiliation(s)
- Anna Meade
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian Wisecarver
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Justin J Davis
- Institute for Plastic Surgery, Southern Illinois University, Springfield, IL
| | - Sofia Duque
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jordyn T Farewell
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew Y Zhang
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Prendergast K, Kryeziu S, Crago AM. The Evolving Management of Desmoid Fibromatosis. Surg Clin North Am 2022; 102:667-677. [PMID: 35952695 DOI: 10.1016/j.suc.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Desmoid fibromatosis is a rare disease caused by genetic alterations that activate β-catenin. The tumors were previously treated with aggressive surgeries but do not metastasize and may regress spontaneously. For these reasons, in the absence of symptoms and when growth would not induce significant complications, active observation is considered first-line therapy. When intervention is required, surgery can be considered based on anatomy and risk of postoperative recurrence, but increasingly nonoperative therapies such as liposomal doxorubicin or sorafenib are prescribed. Cryoablation, chemoembolization, and high-intensity focused ultrasound can also be used to obtain local control in selected patients.
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Affiliation(s)
- Katherine Prendergast
- Sarcoma Biology Laboratory, Memorial Sloan Kettering Cancer Center, 417 East 68th Street, ZRC 445, New York, NY 10065, USA
| | - Sara Kryeziu
- Department of General Surgery, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - Aimee M Crago
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA.
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Prognostic factors of abdominal desmoid tumor fibromatosis after surgery: A retrospective study of 52 patients. Asian J Surg 2022; 45:1770-1771. [DOI: 10.1016/j.asjsur.2022.03.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
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Yin JQ, Fu YW, Gao ZH, Zou CY, Xie XB, Wang B, Zhong ZH, Huang G, Shen JN. A Novel Method to Treat Progressive Desmoid Tumors Involving Neurovascular Bundles: A Retrospective Cohort Study. Neurosurgery 2021; 88:1095-1102. [PMID: 33556169 PMCID: PMC8117464 DOI: 10.1093/neuros/nyaa589] [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: 07/04/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More effective therapies are needed to treat progressive desmoid tumors when active surveillance and systemic therapy fail. OBJECTIVE To assess the efficacy and safety of sandwich isolation surgery on the local control of progressive desmoid tumors involving neurovascular bundles. METHODS A total of 27 patients with progressive desmoid tumors at extremities involving neurovascular bundles who received surgery at our hospital between August 2014 and August 2018 were identified. A total of 13 patients received sandwich isolation surgery, in which R2 resection was performed in neurovasculature-involving regions, and a biomaterial patch was used to envelop involved neurovascular structures and isolate residual tumors. In non-neurovasculature-involving regions, wide resection was performed without isolation. A total of 14 patients received traditional surgery, which included tumor resection without isolation procedure. RESULTS In sandwich isolation group, tumor progressions and local recurrences occurred in 3 patients outside the isolated neurovasculature-involving regions. However, no progressions or recurrences occurred in any patients in the isolated neurovasculature-involving regions where R2 resection was performed. Sandwich isolation surgery group and traditional surgery group shared similar baseline clinical characteristics. The estimated 3-yr event-free survival rate was 76.9% after sandwich isolation surgery, and 32.7% after traditional surgery (P = .025). Patients who received sandwich isolation surgery were less likely to have local recurrence (hazard ratio: 0.257, P = .040). No complications were noted except intermittent mild pain in operative regions (2 cases). CONCLUSION Sandwich isolation surgery is effective and safe for local control of desmoid tumors involving neurovascular bundles.
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Affiliation(s)
- Jun-Qiang Yin
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Yi-Wei Fu
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhen-Hua Gao
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chang-Ye Zou
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xian-Biao Xie
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo Wang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi-Hai Zhong
- Department of Pediatric Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Huang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jing-Nan Shen
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
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Magnetic Resonance Imaging, the Virtual Biopsy of Mesenteric Masses. J Comput Assist Tomogr 2021; 45:177-190. [PMID: 33512853 DOI: 10.1097/rct.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The mesentery may be affected by multiple disease processes. Magnetic resonance imaging aids as a virtual pathological biopsy tool in the assessment of mesenteric masses because of superior soft tissue contrast and characterization. In this comprehensive review, we describe in detail the magnetic resonance imaging features of some solid and cystic mesenteric masses, with an emphasis on lesion-specific signal characteristics on T1- and T2-weighted images, diffusion-weighted imaging, and enhancement features on the dynamic postcontrast phase that aid in narrowing the differential diagnosis.
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Guo L, Wang X, Xu B, Lang R, Hu B. Prognostic significance of CTNNB1 mutation in recurrence of sporadic desmoid tumors. Future Oncol 2021; 17:435-442. [PMID: 33397129 DOI: 10.2217/fon-2020-0544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Desmoid tumor (DT) is a rare, locally aggressive benign neoplasm with a high recurrence rate. The majority of sporadic DTs are associated with mutations in CTNNB1, but whether CTNNB1 mutations are associated with the risk of DT recurrence remains unclear. The goal of this meta-analysis was to evaluate the association between CTNNB1 mutation and recurrence in surgically treated DT patients. Methods: PubMed, Embase and Cochrane library were systematically searched. The outcome of interest was the risk of recurrence. The number of patients with CTNNB1 mutation and the number of recurrences they developed were recorded and compared. The quality of these studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios and variances were calculated and pooled. Results: A total of eight studies were identified including 637 patients. S45F-mutated DTs were more likely to recur compared with wild type, T41A and other mutated DTs. However, there were no statistically significant differences in the rate of recurrence between wild type and T41A mutation or other mutation. Conclusions: Among CTNNB1 mutations, the mutation S45F is a high-risk factor for recurrence of DT and may be a predictive marker for the recurrence of sporadic DT.
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Affiliation(s)
- Lifang Guo
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xin Wang
- Pharmacy Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Benshan Xu
- Pharmacy Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ren Lang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
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Jin L, Tan Y, Su Z, Huang S, Pokhrel S, Shi H, Chen Y. Gardner syndrome with giant abdominal desmoid tumor during pregnancy: a case report. BMC Surg 2020; 20:282. [PMID: 33183289 PMCID: PMC7664105 DOI: 10.1186/s12893-020-00944-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Gardner syndrome is a subtype of familial adenomatous polyposis (FAP), characterized by a combination of adenomatous intestinal polyps and extracolonic lesions such as multiple osteomas, dental abnormalities, and soft tissue tumors. Although 12% of patients with intestinal polyposis of FAP may occur intra-abdominal desmoid tumors, pregnancy complicating with giant abdominal desmoid tumors is a relatively rare case. Case presentation A 28-year-old pregnant woman was diagnosed with Gardner syndrome in whom an intra-abdominal tumor was found a year after undergoing a laparoscopic total colectomy due to family adenomatous polyposis. At 32 weeks’ gestation, she presented to our department for the third time complaining upper abdominal pain caused by the giant abdominal mass about 21 × 12 cm2 in size. After multidisciplinary consultation and discussion, the decision of fetal preservation treatment was made. After the delivery of a baby girl, abdominal mass resection was performed, and pathological examination revealed a fibrous adenoma. The patient was discharged after a week and was uneventful in the follow-up for half a year. Conclusions Gardner syndrome is characterized by typical syndrome including family adenomatous polyposis and extra-intestinal tissue tumor. Were desmoid tumors rarely as large as fetus and local aggressively. In our case, we selected surgery to remove the intra-abdominal desmoid tumor after the natural delivery of the fetus and no abnormalities were observed during the 6 months follow-up. Women during pregnancy have an increased risk for the development of desmoid tumors, likely with the sex hormone to be one of the triggers. Therefore, we suggested that when a patient with Gardner syndrome desire to conceive again, they should go to the hospital for a regular review at least once every 3 months.
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Affiliation(s)
- Liquan Jin
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Yunbo Tan
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Ziting Su
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Shan Huang
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Sita Pokhrel
- Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Hongbo Shi
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Yiming Chen
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China. .,Institute of Translational Medicine for Metabolic Diseases, Dali University, Dali, Yunnan Province, China.
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Salas S, Chibon F. [Biology and signaling pathways involved in the oncogenesis of desmoid tumors]. Bull Cancer 2020; 107:346-351. [PMID: 31955867 DOI: 10.1016/j.bulcan.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022]
Abstract
Desmoid tumors (TDs) are derived from mesenchymal stem cells and their pathogenesis is strongly linked to the Wingless/Wnt cascade where the deregulation of β-catenin plays a major role. A mutation of the CTNNB1 encoding β-catenin is found in the majority of sporadic TD cases and constitutional mutations of APC have been described in heritable forms in patients with familial adenomatous polyposis (FAP). Estrogens could also play a role in pathogenesis and this is the basis for the use of hormone therapy. Other signaling pathways have been involved in the development of TDs such as Notch, Hedgehog, JAK/STAT, PI3 Kinase/AKT and mTOR. Metalloproteases are expressed in TDs and play a role in invasiveness. TGF-ß, as a growth factor, stimulates the transcriptional activity of β-catenin. Future studies will need to focus on better describing and understanding the immune environment of TDs. One of the major difficulties for the experimental study of TDs is the virtual absence of a preclinical model, either in vitro or in vivo. This is partly why the interactions between the different signaling pathways presented here and their consequences for the development of TDs are still poorly understood.
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Affiliation(s)
- Sébastien Salas
- AP-HM, Aix-Marseille university, department of medical oncology, 13005, Marseille, France.
| | - Frédéric Chibon
- Institut Claudius Régaud, Cancer Research Center in Toulouse (CRCT), IUCT-oncopole, Inserm U1037, 31000, Toulouse, France
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Local Control and Analgesic Efficacy of Percutaneous Cryoablation for Desmoid Tumors. Cardiovasc Intervent Radiol 2019; 43:110-119. [PMID: 31471720 DOI: 10.1007/s00270-019-02323-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Cryoablation is being more and more often used to treat desmoid tumors. We report our experience of cryoablation as a local and analgesic treatment for inoperable or recurring desmoid tumors. METHODS This study includes 34 patients who underwent percutaneous cryoablation of 41 desmoid tumors between July 2012 and September 2016. All patients underwent pain assessment using a visual analog scale (VAS) and preoperative imaging. All cryoablation procedures were performed using the same cryoablation system. Patients received clinical and radiological follow-up at 6 months post-procedure, with pain-rating and adverse events being recorded. A long-term follow-up was achieved until 31 December 2018. Disease-free survival at 3 years was also recorded. Radiological tumor response was determined by tumor measurements using RECIST 1.1. RESULTS Twelve patients benefitted from curative treatment on 100% of the tumor volume, but 22 patients received debulking treatment because of the risk of neighboring structures. Two patients had a postoperative hematoma grade 2 of the CIRSE classification system for complications, and two patients had grade 4 complications involving palsy of the common fibular nerve. Disease-free survival at 3 years was 42.2%. The mean VAS pain scores were 5.7 and 2.4 at pretreatment and 6 months, respectively, showing a mean reduction of 3.3 (p < 0.001). At 6 months, all measured tumor dimensions were significantly lower than pretreatment. CONCLUSION Cryoablation is an effective therapeutic option for the local treatment and for the analgesic management of desmoid tumors.
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Timbergen MJM, Smits R, Grünhagen DJ, Verhoef C, Sleijfer S, Wiemer EAC. Activated Signaling Pathways and Targeted Therapies in Desmoid-Type Fibromatosis: A Literature Review. Front Oncol 2019; 9:397. [PMID: 31165043 PMCID: PMC6534064 DOI: 10.3389/fonc.2019.00397] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/26/2019] [Indexed: 12/17/2022] Open
Abstract
Desmoid-type fibromatosis (DTF) is a rare, soft tissue tumor of mesenchymal origin which is characterized by local infiltrative growth behavior. Besides “wait and see,” surgery and radiotherapy, several systemic treatments are available for symptomatic patients. Recently, targeted therapies are being explored in DTF. Unfortunately, effective treatment is still hampered by the limited knowledge of the molecular mechanisms that prompt DTF tumorigenesis. Many studies focus on Wnt/β-catenin signaling, since the vast majority of DTF tumors harbor a mutation in the CTNNB1 gene or the APC gene. The established role of the Wnt/β-catenin pathway in DTF forms an attractive therapeutic target, however, drugs targeting this pathway are still in an experimental stage and not yet available in the clinic. Only few studies address other signaling pathways which can drive uncontrolled growth in DTF such as: JAK/STAT, Notch, PI3 kinase/AKT, mTOR, Hedgehog, and the estrogen growth regulatory pathways. Evidence for involvement of these pathways in DTF tumorigenesis is limited and predominantly based on the expression levels of key pathway genes, or on observed clinical responses after targeted treatment. No clear driver role for these pathways in DTF has been identified, and a rationale for clinical studies is often lacking. In this review, we highlight common signaling pathways active in DTF and provide an up-to-date overview of their therapeutic potential.
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Affiliation(s)
- Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC-University Medical Center, Rotterdam, Netherlands.,Department of Medical Oncology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Ron Smits
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Erik A C Wiemer
- Department of Medical Oncology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
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Enzo MV, Cattelan P, Rastrelli M, Tosi A, Rossi CR, Hladnik U, Segat D. Growth rate and myofibroblast differentiation of desmoid fibroblast-like cells are modulated by TGF-β signaling. Histochem Cell Biol 2018; 151:145-160. [DOI: 10.1007/s00418-018-1718-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 02/06/2023]
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Libertini M, Mitra I, van der Graaf WTA, Miah AB, Judson I, Jones RL, Thomas K, Moskovic E, Szucs Z, Benson C, Messiou C. Aggressive fibromatosis response to tamoxifen: lack of correlation between MRI and symptomatic response. Clin Sarcoma Res 2018; 8:13. [PMID: 29785261 PMCID: PMC5950191 DOI: 10.1186/s13569-018-0100-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/04/2018] [Indexed: 01/22/2023] Open
Abstract
Background One of the commonly used systemic agents for the treatment of aggressive fibromatosis is the anti-oestrogen drug tamoxifen. However, data on efficacy and optimum methods of response assessment are limited, consisting mainly of small case series and reports. Methods A retrospective database was used to identify consecutive patients diagnosed with aggressive fibromatosis (AF) and treated with tamoxifen plus/minus non-steroidal anti-inflammatory drugs at our tertiary referral centre between 2007 and 2014. MRI and symptom changes were recorded. Results Thirty-two patients (13 male 19 female, median age 41 years) were included. Median duration of treatment with tamoxifen was 316 days. Of 9 patients with progressive disease by RECIST 1.1 (28%): 4 patients experienced worsening symptoms; 3 patients had improved symptoms and 2 had no change in symptoms. Of 22 patients with stable disease (69%): 11 had no change in symptoms; 6 had improved symptoms and 5 patients had worsening symptoms. One patient achieved a partial response with improved symptoms. Conclusions No relationship was identified between symptomatic benefit and response by RECIST 1.1 on MRI. Prospective studies in AF should incorporate endpoints focusing on patient symptoms.
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Affiliation(s)
- M Libertini
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - I Mitra
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,2Department of Radiology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - W T A van der Graaf
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - A B Miah
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - I Judson
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - R L Jones
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - K Thomas
- 2Department of Radiology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - E Moskovic
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - Z Szucs
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - C Benson
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - C Messiou
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,2Department of Radiology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK.,3Institute of Cancer Research, Sutton, UK
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Kocak Z, Adli M, Erdir O, Erekul S, Cakmak A. Intrathoracic Desmoid Tumor of the Posterior Mediastinum with Transdiaphragmatic Extension. Report of a Case. TUMORI JOURNAL 2018; 86:489-91. [PMID: 11218194 DOI: 10.1177/030089160008600613] [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: 11/17/2022]
Abstract
We report on a de novo desmoid tumor of the posterior mediastinum with transdiaphragmatic extension in a 40-year-old man. The tumor was inoperable because of its location and the invasion of adjacent structures. Although extremely rare, desmoid tumors of the posterior mediastinum should be considered in the differential diagnosis of posterior mediastinal masses.
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Affiliation(s)
- Z Kocak
- Department of Radiation Oncology, Ankara University Medical School, Turkey.
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15
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Bulut G, Ozluk A, Erdogan AP, Uslu R, Elmas N, Karaca B. Pazopanib: a novel treatment option for aggressive fibromatosis. Clin Sarcoma Res 2016; 6:22. [PMID: 27957320 PMCID: PMC5131445 DOI: 10.1186/s13569-016-0061-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aggressive fibromatosis (AF), also known as desmoid tumor, is an uncommon soft tissue neoplasm. AF does not metastasize, but it is locally invasive and its propensity for recurrence after conservative resection is well documented. No effective cytotoxic treatment has been reported, hence there is a need for novel treatment strategies. CASE PRESENTATION We present the case of an AF successfully treated with an oral tyrosine kinase inhibitor, pazopanib, with mild side effects. As far as we know, this is the first case of AF with complete response to pazopanib. CONCLUSION Pazopanib might be an effective treatment option for AF.
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Affiliation(s)
- Gulcan Bulut
- Department of Medical Oncology, Ege University Medical School, Tulay Aktas Oncology Hospital, Ege University, Izmir, Turkey
| | - Anil Ozluk
- Department of Internal Medicine, Ege University Medical School, Ege University Medical School Hospital, Ege University, Izmir, Turkey
| | - Atike Pınar Erdogan
- Department of Medical Oncology, Ege University Medical School, Tulay Aktas Oncology Hospital, Ege University, Izmir, Turkey
| | - Ruchan Uslu
- Department of Medical Oncology, Ege University Medical School, Tulay Aktas Oncology Hospital, Ege University, Izmir, Turkey
| | - Nevra Elmas
- Department of Radiology, Ege University Medical School, Ege University Medical School Hospital, Ege University, Izmir, Turkey
| | - Burcak Karaca
- Department of Medical Oncology, Ege University Medical School, Tulay Aktas Oncology Hospital, Ege University, Izmir, Turkey
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16
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17
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Sato S, Tang YJ, Wei Q, Hirata M, Weng A, Han I, Okawa A, Takeda S, Whetstone H, Nadesan P, Kirsch DG, Wunder JS, Alman BA. Mesenchymal Tumors Can Derive from Ng2/Cspg4-Expressing Pericytes with β-Catenin Modulating the Neoplastic Phenotype. Cell Rep 2016; 16:917-927. [PMID: 27425618 PMCID: PMC4963269 DOI: 10.1016/j.celrep.2016.06.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 05/02/2016] [Accepted: 06/11/2016] [Indexed: 02/07/2023] Open
Abstract
The cell of origin for most mesenchymal tumors is unclear. One cell type that contributes to this lineages is the pericyte, a cell expressing Ng2/Cspg4. Using lineage tracing, we demonstrated that bone and soft tissue sarcomas driven by the deletion of the Trp53 tumor suppressor, or desmoid tumors driven by a mutation in Apc, can derive from cells expressing Ng2/Cspg4. Deletion of the Trp53 tumor suppressor gene in these cells resulted in the bone and soft tissue sarcomas that closely resemble human sarcomas, while stabilizing β-catenin in this same cell type caused desmoid tumors. Comparing expression between Ng2/Cspg4-expressing pericytes lacking Trp53 and sarcomas that arose from deletion of Trp53 showed inhibition of β-catenin signaling in the sarcomas. Activation of β-catenin inhibited the formation and growth of sarcomas. Thus, pericytes can be a cell of origin for mesenchymal tumors, and β-catenin dysregulation plays an important role in the neoplastic phenotype.
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Affiliation(s)
- Shingo Sato
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Department of Orthopaedic Surgery, Tokyo Medical and Dental, University Graduate School and Faculty of Medicine, Tokyo 113-8510, Japan; Department of Physiology and Cell Biology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Yuning J Tang
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
| | - Qingxia Wei
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Makoto Hirata
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Angela Weng
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul 151-742, Republic of Korea
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental, University Graduate School and Faculty of Medicine, Tokyo 113-8510, Japan
| | - Shu Takeda
- Department of Physiology and Cell Biology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Heather Whetstone
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Puvindran Nadesan
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
| | - David G Kirsch
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA; Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Jay S Wunder
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Benjamin A Alman
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA.
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18
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Ergen ŞA, Tiken EE, Öksüz DÇ, Dinçbaş FÖ, Dervişoğlu S, Mandel NM, Hız M, Koca S. The Role of Radiotherapy in the Treatment of Primary or Recurrent Desmoid Tumors and Long-Term Results. Balkan Med J 2016; 33:316-21. [PMID: 27308076 DOI: 10.5152/balkanmedj.2016.140560] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/03/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Desmoid tumors are uncommon and benign mesenchymal neoplasms. The optimal treatment of patients with desmoid tumors is still controversial. Surgery is the primary treatment for locally invasive or recurrent desmoid tumors. Also, radiotherapy is a treatment option for patients at high risk for local failure such as those with positive margins or recurrent and unresectable tumors. AIMS To report our institutional experience and long-term results of patients with desmoid tumors who received radiotherapy. STUDY DESIGN Retrospective cross-sectional study. METHODS Between 1980 and 2009, 20 patients who received radiotherapy (RT) in our institution were analyzed. The majority of patients (80%) were referred with a recurrent tumor after previous surgery. Thirteen patients underwent marginal resection, 4 had wide local excision and 3 patients had only biopsy. Resection margin was positive in 15 (75%) patients. All patients received radiation therapy. The median prescribed dose was 60 Gy. Five patients received less than 54 Gy. RESULTS The median follow-up time was 77.5 months (28-283 months). Nine patients developed local recurrence after RT. Seven local failures (78%) were in field. Time to local recurrence ranged from 3-165 months (median 33 months). The 2-5 year local control (LC) rates were 80% and 69%, respectively. On univariate analysis, the 5 year local control rate was significantly better in the patients treated with ≥54 Gy than in patients who received <54 Gy (p=0.023). The most common acute side effect was grade 1-2 skin toxicity. As a late side effect of radiotherapy, soft tissue fibrosis was detected in 10 patients and lymphangitis was seen in 1 patient. One patient developed radiation-induced sarcoma. CONCLUSION According to our results, radiotherapy is especially effective in recurrent disease and provides a high local control rate in the patients received more than 54 Gy.
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Affiliation(s)
- Şefika Arzu Ergen
- Department of Radiation Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Elif Eda Tiken
- Department of Radiation Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Didem Çolpan Öksüz
- Department of Radiation Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fazilet Öner Dinçbaş
- Department of Radiation Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Sergülen Dervişoğlu
- Department of Pathology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Nil Molinas Mandel
- Department of Medical Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Murat Hız
- Department of Orthopedic Surgery, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Sedat Koca
- Department of Radiation Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
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19
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Campara Z, Spasic A, Aleksic P, Milev B. An Aggressive Retroperitoneal Fibromatosis. Med Arch 2016; 70:154-7. [PMID: 27147794 PMCID: PMC4851536 DOI: 10.5455/medarh.2016.70.154-157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: Aggressive fibromatosis (AF) is a heterogeneous group of mesenchymal tumors that have locally infiltrative growth and a tendency to relapse. The clinical picture is often conditioned by the obstruction of the ureter or small intestine. Diagnosis is based on clinical, radiological and histological parameters. A case report: We report a case of male patient, aged 35 years, with the retroperitoneal fibromatosis. He reported to the physician because of frequent urination with the feeling of pressure and pain. Computed tomography revealed the tumor mass on the front wall of the bladder with diameter of 70mm with signs of infiltration of the musculature of the anterior abdominal wall. Endoscopic transurethral biopsy showed proliferative lesion binders by type of fibromatosis. The tumor was surgically removed in a classical way. The patient feels well and has no recurrence thirty-six months after the operative procedure. Conclusion: The complete tumor resection is the therapeutic choice for the primary tumor as well as for a relapse.
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Affiliation(s)
- Zoran Campara
- Department of Urology, Military Medical Academy, Belgrade, Serbia
| | | | - Predrag Aleksic
- Department of Urology, Military Medical Academy, Belgrade, Serbia
| | - Bosko Milev
- Department of Abdominal Surgery, Military Medical Academy, Belgrade, Serbia
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20
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Burtenshaw SM, Cannell AJ, McAlister ED, Siddique S, Kandel R, Blackstein ME, Swallow CJ, Gladdy RA. Toward Observation as First-line Management in Abdominal Desmoid Tumors. Ann Surg Oncol 2016; 23:2212-9. [DOI: 10.1245/s10434-016-5159-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Indexed: 11/18/2022]
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21
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Lee JH, Jeong JS, Kim SR, Jin GY, Chung MJ, Kuh JH, Lee YC. Mediastinal Desmoid Tumor With Remarkably Rapid Growth: A Case Report. Medicine (Baltimore) 2015; 94:e2370. [PMID: 26717381 PMCID: PMC5291622 DOI: 10.1097/md.0000000000002370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Desmoid tumors (DTs) are a group of rare and benign soft tissue tumors that result from monoclonal proliferation of well-differentiated fibroblasts. Since DTs tend to infiltrate and compress adjacent structures, the location of DTs is one of the most crucial factors for determining the severity of the disease. Furthermore, DTs can further complicate the clinical course of patients when the growth is remarkably rapid, especially for DTs occurring in anatomically critical compartments, including the thoracic cavity.The authors report a case of a 71-year-old man with a known mediastinal mass incidentally detected 4 months ago, presenting dyspnea with right-sided atelectasis and massive pleural effusion. Imaging studies revealed a 16.4 × 9.4-cm fibrous mass with high glucose metabolism in the anterior mediastinum. The mass infiltrated into the chest wall and also displaced the mediastinum contralaterally. Interestingly, the tumor had an extremely rapid doubling time of 31.3 days.En bloc resection of the tumor was performed as a curative as well as a diagnostic measure. Histopathologic examination showed spindle cells with low cellularity and high collagen deposition in the stroma. Immunohistochemical staining was positive for nuclear β-catenin. Based on these pathologic findings, the mass was diagnosed as DT. After surgery, there has been no evidence of recurrence of disease in the patient.This patient presents a mediastinal DT with extremely rapid growth. Notably, the doubling time of DT in our case was the shortest among reported cases of DT. Our experience also highlights the benefits of early interventional strategy, especially for rapidly growing DTs in the thoracic cavity.
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Affiliation(s)
- Joon Hyung Lee
- From the Department of Internal Medicine and Research Center for Pulmonary Disorders (JHL, JSJ, SRK, YCL); Department of Radiology (GYJ); Department of Pathology (MJC); and Department of Thoracic & Cardiovascular Surgery (JHK), Chonbuk National University Medical School, Jeonju, South Korea
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22
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Kamali F, Wang WL, Guadagnolo BA, Fox PS, Lewis VO, Lazar AJ, Conley AP, Ravi V, Toliyat M, Ladha HS, Hobbs BP, Amini B. MRI may be used as a prognostic indicator in patients with extra-abdominal desmoid tumours. Br J Radiol 2015; 89:20150308. [PMID: 26577289 DOI: 10.1259/bjr.20150308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the association of MRI features of extra-abdominal desmoid tumours (DTs) with prognosis. METHODS MRIs for 90 patients with DT were retrospectively reviewed for imaging features associated with biological behaviour. The primary end point was progression (for lesions managed with chemotherapy, radiation therapy and observation) or recurrence (following surgery). Time to event was studied using univariate and multivariable Cox proportional hazards regression models when accounting for demographic, clinicopathological and imaging variables. Kaplan-Meier plots were used to estimate event-free rate (EFR). RESULTS Univariate analysis revealed a significant relationship between EFR and treatment, location and compartment of origin [subcutaneous (SC), superficial fascial, intramuscular (IM) and deep fascial/intermuscular]. None of the imaging features commonly associated with biological behaviour of DTs (e.g., shape, enhancement, T2 signal etc.) or surgical margins (in surgical cases) was associated with EFR. Multivariate analysis showed that treatment modality and compartment of origin were independent predictors of EFR. Superficial and deep fascial lesions had a significantly worse EFR as a group [hazard ratio: 3.9; 95% confidence interval (CI): 1.83-8.32; p = 0.0004] than did the SC and IM lesions as a group. 5-year EFR for the fascial lesions was 18% (95% CI: 6-36%), compared with 57% (95% CI: 25-79%) for the SC and IM groups. CONCLUSION Intramuscular or SC DTs may be associated with improved prognosis. If validated on multireader and prospective studies, these results can provide for rapid risk stratification at the time of initial MRI. ADVANCES IN KNOWLEDGE This work has shown that imaging features commonly associated with biological activity of desmoid tumours (e.g. shape, T2 signal and enhancement) do not appear to be associated with prognosis in patients undergoing a variety of treatment modalities. The compartment of origin of the lesion, which can be determined on pre-operative MRI, was shown to be associated with prognosis and can allow for risk stratification in patients with DTs.
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Affiliation(s)
- Firouzeh Kamali
- 1 Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,2 Department of Diagnostic Radiology, University of Texas at Houston, Houston, TX, USA
| | - Wei-Lien Wang
- 3 Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - B A Guadagnolo
- 4 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,5 Departments of Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Patricia S Fox
- 6 Departments of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Valerae O Lewis
- 7 Departments of Orthopedic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Alexander J Lazar
- 3 Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Anthony P Conley
- 8 Departments of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Vinod Ravi
- 8 Departments of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mohammad Toliyat
- 9 Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Harshad S Ladha
- 1 Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Brian P Hobbs
- 5 Departments of Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Behrang Amini
- 1 Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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23
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Shang H, Braggio D, Lee YJ, Al Sannaa GA, Creighton CJ, Bolshakov S, Lazar AJF, Lev D, Pollock RE. Targeting the Notch pathway: A potential therapeutic approach for desmoid tumors. Cancer 2015; 121:4088-96. [PMID: 26349011 PMCID: PMC4635059 DOI: 10.1002/cncr.29564] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/23/2015] [Accepted: 02/12/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Desmoid tumors (DTs) are rare mesenchymal lesions that can recur repeatedly. When it is feasible, DTs are surgically resected; however, this often results in high recurrence rates. Recently, treatment with PF‐03084014, a potent γ‐secretase inhibitor, has been shown to have antitumor activity in several tumor types by affecting the WNT/β‐catenin pathway. Consequently, Notch pathway inhibition by PF‐03084014 might be a promising approach for DT treatment. METHODS The expression of Notch pathway components was analyzed in DT tissues and cell strains with immunohistochemistry and Western blotting, respectively. A panel of DT cell strains was exposed to PF‐03084014 and evaluated for cell proliferation. Antitumor effects were assessed via cell cycle, apoptosis, and migration and invasion analysis. Cells treated with PF‐03084014 were characterized with a gene array analysis combined with Ingenuity Pathway Analysis. RESULTS The results showed that Notch pathway components were expressed at different levels in DTs. Hes1 (Hes Family BHLH Transcription Factor 1) was overexpressed in DT tumors versus dermal scar tissue, and PF‐03084014 caused significant decreases in Notch intracellular domain and Hes1 expression in DT cell strains. PF‐03084014 decreased DT cell migration and invasion and also caused cell growth inhibition in DT cell strains, most likely through cell cycle arrest. Gene array analysis combined with Ingenuity Pathway Analysis showed that Wnt1‐inducible signaling pathway protein 2 possibly regulated Notch and WNT pathways after treatment with PF‐03084014 through integrin. CONCLUSION Our findings suggest that the Notch pathway is an important DT therapeutic target. Furthermore, PF‐03084014 has significant antitumor activity against DTs, and it may be an alternative strategy for DT treatment. Cancer 2015;121:4088–4096. © 2015 American Cancer Society. The Notch pathway is an important therapeutic target for desmoid tumors, and the γ‐secretase inhibitor PF‐03084014 has significant antitumor activity against desmoid tumors. The use of this inhibitor may be an alternative strategy for desmoid tumor treatment.
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Affiliation(s)
- Hui Shang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Danielle Braggio
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Surgical Oncology, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.,Department of Investigative Pathology, International Center for Research, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Ya-Jung Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ghadah A Al Sannaa
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chad J Creighton
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Svetlana Bolshakov
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander J F Lazar
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Sarcoma Research Center, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dina Lev
- Surgery B, Sheba Medical Center, Tel Aviv, Israel
| | - Raphael E Pollock
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Surgical Oncology, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.,Sarcoma Research Center, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Crago AM, Chmielecki J, Rosenberg M, O'Connor R, Byrne C, Wilder FG, Thorn K, Agius P, Kuk D, Socci ND, Qin LX, Meyerson M, Hameed M, Singer S. Near universal detection of alterations in CTNNB1 and Wnt pathway regulators in desmoid-type fibromatosis by whole-exome sequencing and genomic analysis. Genes Chromosomes Cancer 2015; 54:606-15. [PMID: 26171757 DOI: 10.1002/gcc.22272] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 12/17/2022] Open
Abstract
CTNNB1 mutations or APC abnormalities have been observed in ∼85% of desmoids examined by Sanger sequencing and are associated with Wnt/β-catenin activation. We sought to identify molecular aberrations in "wild-type" tumors (those without CTNNB1 or APC alteration) and to determine their prognostic relevance. CTNNB1 was examined by Sanger sequencing in 117 desmoids; a mutation was observed in 101 (86%) and 16 were wild type. Wild-type status did not associate with tumor recurrence. Moreover, in unsupervised clustering based on U133A-derived gene expression profiles, wild-type and mutated tumors clustered together. Whole-exome sequencing of eight of the wild-type desmoids revealed that three had a CTNNB1 mutation that had been undetected by Sanger sequencing. The mutation was found in a mean 16% of reads (vs. 37% for mutations identified by Sanger). Of the other five wild-type tumors sequenced, two had APC loss, two had chromosome 6 loss, and one had mutation of BMI1. The finding of low-frequency CTNNB1 mutation or APC loss in wild-type desmoids was validated in the remaining eight wild-type desmoids; directed miSeq identified low-frequency CTNNB1 mutation in four and comparative genomic hybridization identified APC loss in one. These results demonstrate that mutations affecting CTNNB1 or APC occur more frequently in desmoids than previously recognized (111 of 117; 95%), and designation of wild-type genotype is largely determined by sensitivity of detection methods. Even true CTNNB1 wild-type tumors (determined by next-generation sequencing) may have genomic alterations associated with Wnt activation (chromosome 6 loss/BMI1 mutation), supporting Wnt/β-catenin activation as the common pathway governing desmoid initiation.
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Affiliation(s)
- Aimee M Crago
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Juliann Chmielecki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA
| | - Mara Rosenberg
- Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA
| | - Rachael O'Connor
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Caitlin Byrne
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fatima G Wilder
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine Thorn
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Phaedra Agius
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deborah Kuk
- Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicholas D Socci
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Li-Xuan Qin
- Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA.,Department of Pathology, Harvard Medical School, Boston, MA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Sarcoma Biology Laboratory and Sarcoma Disease Management Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Surgery, Weill Cornell Medical College, New York, NY
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25
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Desmoid Tumor of the Popliteal Fossa during Pregnancy. Case Rep Surg 2015; 2015:262654. [PMID: 25734019 PMCID: PMC4334983 DOI: 10.1155/2015/262654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/24/2015] [Indexed: 12/03/2022] Open
Abstract
Desmoid tumors are fibroblastic neoplasms that have an intermediate behavior with a highly aggressive infiltrative growth arising from deep muscle or aponeurosis. We present the case of a 34-year-old woman that developed a painless mass in the right popliteal fossa during pregnancy after intracytoplasmic sperm injection and hormonal therapy. The MRI scan showed a hyperintense mass of 6,7 cm × 4,7 cm × 3,8 cm surrounding the lateral head of the gastrocnemius muscle. The open biopsy was done one week after delivery, and the histology showed a desmoid tumor. We performed the resection one week later and found the common peroneal nerve completely surrounded by the tumor. The close resection due to the neurolysis was the reason why an adjuvant radiation with 56 Gy was done. The last clinical examination, 18 month later, did not show any signs of recurrence and an excellent functional outcome. This case demonstrates the possible influences of pregnancy and hormonal therapy on the evolution of desmoid tumors.
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26
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Foà R, Rizzo S, Petrella F, De Maria F, Bellomi M. Recurrent aggressive fibromatosis of the chest wall. Ecancermedicalscience 2014; 8:464. [PMID: 25368668 PMCID: PMC4170978 DOI: 10.3332/ecancer.2014.464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Indexed: 11/06/2022] Open
Abstract
A 57-year-old woman with a previous history of aesthetic surgery for breast reduction presented with a subcutaneous mass in the right axilla. A CT scan showed a solid mass on the chest wall, and she underwent surgical resection with a diagnosis of aggressive fibromatosis. After a 10-month period of follow-up, a local recurrence occurred, and in accordance with the up-to-date approach, the recurrence has been treated with a conservative approach (medical treatments) with good control of the symptoms and downsizing of the lesion.
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Affiliation(s)
- Riccardo Foà
- Department of Health Sciences, University of Milan, via A. di Rudinì 8, Milan 20142, Italy
| | - Stefania Rizzo
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, Milan 20141, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, via Ripamonti 435, Milan 20141, Italy
| | - Federica De Maria
- Department of Health Sciences, University of Milan, via A. di Rudinì 8, Milan 20142, Italy
| | - Massimo Bellomi
- Department of Health Sciences, University of Milan, via A. di Rudinì 8, Milan 20142, Italy ; Department of Radiology, European Institute of Oncology, via Ripamonti 435, Milan 20141, Italy
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Targeting stem cell behavior in desmoid tumors (aggressive fibromatosis) by inhibiting hedgehog signaling. Neoplasia 2014; 15:712-9. [PMID: 23814483 DOI: 10.1593/neo.13452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 04/13/2013] [Accepted: 04/15/2013] [Indexed: 12/28/2022] Open
Abstract
Desmoid tumor (also called aggressive fibromatosis) is a lesion of mesenchymal origin that can occur as a sporadic tumor or a manifestation of the preneoplastic syndrome, familial adenomatous polyposis caused by a mutation in adenomatous polyposis coli (APC). This tumor type is characterized by the stabilization of β-catenin and activation of Tcf-mediated transcription. Cell transplantation data suggest that desmoid tumors are derived from mesenchymal progenitor cells (MSCs). As such, modulating cell signaling pathways that regulate MSC differentiation or proliferation, such as hedgehog (Hh) signaling, could alter the tumor phenotype. Here, we found that Hh signaling is activated in human and murine desmoid tumors. Inhibiting Hh signaling in human cell cultures decreased cell proliferation and β-catenin protein levels. Apc(+)/Apc(1638N) mice, which develop desmoid tumors, develop smaller and fewer tumors when Hh signaling was inhibited either genetically (by crossing Apc(+)/Apc(1638N) mice with mice lacking one copy of a Hh-activated transcription factor, Gli2 (+/-) mice) or using a pharmacologic inhibitor. Both in mice and in human tumor cell cultures, β-catenin and Hh-mediated signaling positively regulate each other's activity. These data show that targeting a pathway that regulates MSC differentiation influences desmoid tumor behavior, providing functional evidence supporting the notion that these tumors are derived from mesenchymal progenitors. It also suggests Hh blockade as a therapeutic approach for this tumor type.
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Jo JC, Hong YS, Kim KP, Lee JL, Lee J, Park YS, Kim SY, Ryu JS, Lee JS, Kim TW. A prospective multicenter phase II study of sunitinib in patients with advanced aggressive fibromatosis. Invest New Drugs 2014; 32:369-76. [PMID: 24425345 DOI: 10.1007/s10637-013-0059-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/26/2013] [Indexed: 12/29/2022]
Abstract
Several studies have reported that imatinib may induce tumor responses and prolonged disease stabilization in aggressive fibromatosis (AF). This effect may relate to the PDGFR-β pathway and KIT mutations. Sunitinib not only inhibits PDGFRs, KIT, and FLT3, it also blocks VEGFRs and thus serves as an antiangiogenic agent. The aim of this prospective multicenter uncontrolled study was to evaluate the efficacy and safety of sunitinib in patients with advanced AF. Nineteen patients with pathologically proven AF were recruited between June, 2008, and March, 2012, from three centers. One treatment cycle consisted of 37.5 mg/day sunitinib for 4 weeks without a break. The primary endpoint was tumor response rate according to RECIST 1.0. Ten (53 %) patients were female and the median age was 30 years (range, 22-67). Most of the primary sites were intra-abdominal (12, 63.2 %), and AF associated with familial adenomatous polyposis in ten patients (52.6 %). With a median of six cycles per patients (range, 1-47 cycles), five patients (26.3 %) achieved a partial response and eight (42.1 %) had stable disease. The overall response rate was 26.3 % (95 % confidence interval [CI], 6.3-45.7) in intention-to-treat analysis. With a median follow-up time of 20.3 months (range, 1.8-50.7), the 2-year rates of progression-free and overall survival were 74.7 % and 94.4 %, respectively. Grade 3 or 4 adverse events of sunitinib that occurred in >5 % of patients were neutropenia (33.3 %), diarrhea (5.3 %), and hand-foot syndrome (5.3 %). In 3 of 12 patients with mesenteric AF, mesenteric mass bleeding (n = 1), bowel perforation (n = 1), and bowel fistula (n = 1) with tumor mass necrosis were observed early during sunitinib treatment. Therefore, sunitinib showed potential antitumor activity and may be useful for the management of non-mesenteric AF.
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Affiliation(s)
- Jae-Cheol Jo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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de Bree E, Zoras O, Hunt JL, Takes RP, Suárez C, Mendenhall WM, Hinni ML, Rodrigo JP, Shaha AR, Rinaldo A, Ferlito A, de Bree R. Desmoid tumors of the head and neck: a therapeutic challenge. Head Neck 2014; 36:1517-26. [PMID: 24421052 DOI: 10.1002/hed.23496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/22/2013] [Accepted: 09/09/2013] [Indexed: 12/23/2022] Open
Abstract
Desmoid tumor, or aggressive fibromatosis, is a rare, histologically benign, fibroblastic lesion that infrequently presents in the head and neck. Desmoid tumors often grow locally, invasively, and may, in rare instances, be fatal secondary to invasion into critical structures, such as airway or major vessels. The most common treatment is surgery, but desmoid tumors are characteristically associated with a high local recurrence rate after resection. Although the margin status seems to be of importance, operations that avoid function loss and esthetic disfigurement should be the primary goal. The efficacy of postoperative radiotherapy is controversial. Its potential benefit should be carefully balanced against possible radiation-induced adverse effects. Alternative treatment modalities, such as primary radiotherapy and medical treatment or a wait-and-see policy, may be preferable to mutilating surgery. Considering all the aforementioned, it seems obvious that desmoid tumors of the head and neck present a therapeutic challenge and require an individualized approach.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Heraklion, Greece
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Martin-Liberal J, Benson C, McCarty H, Thway K, Messiou C, Judson I. Pazopanib is an active treatment in desmoid tumour/aggressive fibromatosis. Clin Sarcoma Res 2013; 3:13. [PMID: 24279994 PMCID: PMC4176486 DOI: 10.1186/2045-3329-3-13] [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: 11/12/2013] [Accepted: 11/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background Desmoid tumours/aggressive fibromatosis (DT/AF) are infrequent soft-tissue neoplasms. They usually behave as indolent diseases. However, they may grow locally infiltrating or compressing adjacent structures. The role of local treatment is limited and only a few drugs have shown activity. Cases presentation We report the outcome of two patients affected by progressive DT/AF treated with the angiogenesis inhibitor pazopanib in two different institutions. Both patients achieved dramatic improvement in their symptoms and radiological signs of response. The clinical benefit lasted for more than 1 year and it is still ongoing. Conclusions Pazopanib is an active treatment in DT/AF. It is the first time this has been reported.
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Coffin CM, Davis JL, Borinstein SC. Syndrome-associated soft tissue tumours. Histopathology 2013; 64:68-87. [DOI: 10.1111/his.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology; Vanderbilt University School of Medicine; Nashville TN USA
| | - Jessica L Davis
- Department of Anatomic Pathology; Laboratory Medicine; University of California at San Francisco; San Francisco CA USA
| | - Scott C Borinstein
- Division of Pediatric Hematology/Oncology; Department of Pediatrics; Vanderbilt University School of Medicine; Nashville TN USA
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Garvey PB, Booth JH, Baumann DP, Calhoun KA, Liu J, Pollock RE, Butler CE. Complex reconstruction of desmoid tumor resections does not increase desmoid tumor recurrence. J Am Coll Surg 2013; 217:472-80. [PMID: 23816381 DOI: 10.1016/j.jamcollsurg.2013.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND The propensity of desmoid tumors to develop in scars has led some surgeons to limit the complexity of desmoid defect reconstruction as a strategy for avoiding desmoid recurrence. We hypothesized that desmoid recurrence rates are similar despite the magnitude of reconstruction. STUDY DESIGN We retrospectively compared recurrence rates between patients who underwent reconstruction and patients who underwent primary closure without reconstruction after desmoid tumor resection in consecutive patients for 15 years. Univariate and multivariate regression analyzed associations between patient, tumor, and treatment characteristics and outcomes. RESULTS We included 164 consecutive patients (80 [49%] reconstructions vs 84 [51%] primary closures). Mean follow-up duration was 7.1 ± 4.5 years. Patients who underwent reconstruction had more desmoids in an area of earlier trauma or surgery (p < 0.001), greater defect volume (p < 0.01), longer operative time (p < 0.001) and hospital stay (p < 0.001), and more postoperative complications (p = 0.015) compared with the primary closure group. Despite these differences, desmoid recurrence rates were similar for the reconstruction and primary closure groups (30% and 29%, respectively; p = 0.7), as was mean time to tumor recurrence, and no tumors recurred within flap donor sites. Multivariate regression analysis demonstrated the 45F mutation to be the only independent predictor of recurrence (hazard ratio = 1.87; p = 0.04). CONCLUSIONS Rates of desmoid recurrence in resection defects are similar for primary closures and complex reconstructions. Therefore, surgeons should not limit the magnitude of reconstructions in an attempt to avoid tumor recurrence. However, given the propensity of desmoids to recur, reconstructions should allow for the possibility of future resections and reconstructions, particularly in tumors with 45F gene mutations.
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Affiliation(s)
- Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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34
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Mullen JT, DeLaney TF, Rosenberg AE, Le L, Iafrate AJ, Kobayashi W, Szymonifka J, Yeap BY, Chen YL, Harmon DC, Choy E, Yoon SS, Raskin KA, Hornicek FJ, Nielsen GP. β-Catenin mutation status and outcomes in sporadic desmoid tumors. Oncologist 2013; 18:1043-9. [PMID: 23960186 DOI: 10.1634/theoncologist.2012-0449] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Mutations in the gene-encoding β-catenin, CTNNB1, are highly prevalent in sporadic desmoid tumors and may predict the risk for recurrence. We sought to determine the prevalence of CTNNB1 mutations in a large cohort of sporadic desmoid tumors and to determine whether CTNNB1 mutation status correlates with disease outcome. METHODS Single-base extension genotyping of the CTNNB1 gene was performed on 145 sporadic, paraffin-embedded desmoid tumor specimens. Correlation of mutation status with outcome was performed on a subset of 115 patients who underwent macroscopically complete surgical resection. RESULTS CTNNB1 mutations were detected in 106 of 145 (73%) tumor specimens and in 86 of 115 (75%) specimens from patients who underwent curative-intent surgical resection, including discrete mutations in the following codons of CTNNB1 exon 3: T41A (46%), S45F (25%), S45P (1.7%), and S45C (0.9%). Desmoid tumors of the superficial trunk were significantly less likely to harbor CTNNB1 mutations than tumors located elsewhere, but none of the other examined clinicopathologic factors were found to be associated with CTNNB1 mutation status. At a median follow-up of 31 months, 5-year recurrence-free survival was slightly, although not statistically significantly, worse for patients with β-catenin-mutated tumors than for those with wild-type tumors (58% vs. 74%, respectively). The specific CTNNB1 codon mutation did not correlate with the risk for recurrence. CONCLUSION CTNNB1 mutations are indeed common in sporadic desmoid tumors. However, our study did not detect a statistically significant difference in recurrence risk according to either the CTNNB1 mutation status or the specific CTNNB1 mutation.
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Sudden progressive abdominal pain due to large peritoneal desmoid tumor: A case report with review of literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Desmoid tumours of the brachial plexus are rare and may occur in extra-abdominal sites. The tumours are of fibroblastic origin and, although benign, are locally aggressive. Their relationship to critical neurovascular structures in their anatomic locations presents a challenge to the operating surgeons trying to adhere to the principles of surgery. Surprisingly little neurosurgical literature exists which was devoted to this topic despite the challenge these lesions present in surgery both at surgery and in choosing adjuvant therapies.
We report a case of a large brachial plexus tumour in a patient which was diagnosed radiologically and histopathologically and the patient underwent surgical excision with good outcome. Desmoid tumours histologically are benign and are usually composed of proliferating, benign fibroblasts in an abundant matrix of collagen. They do not transform into malignant tumours or metastasize. Surgery is the mainstay of treatment; however, adjuvant radiation and chemotherapy remain controversial.
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Meneghello C, Ousghir B, Rastrelli M, Anesi L, Sommariva A, Montesco MC, Rossi CR, Hladnik U, Segat D. Nuclear GSK-3β segregation in desmoid-type fibromatosis. Histopathology 2013; 62:1098-108. [PMID: 23614534 DOI: 10.1111/his.12133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/19/2013] [Indexed: 12/23/2022]
Abstract
AIMS Desmoid-type fibromatosis (DF) is a rare benign myofibroblastic neoplasm of the connective tissue that is unable to metastasize but is associated with a high local recurrence rate. Nuclear β-catenin is the most commonly used histological marker of DF; however, clinical and biological predictive markers guiding the treatment and follow-up of DF are still lacking. Normally, β-catenin is regulated by the cytoplasmic multiprotein complex of adenomatous polyposis coli (APC), axin, casein kinase 1α (CK1α), and glycogen synthase kinase 3β (GSK-3β); this phosphorylates and degrades β-catenin, which would otherwise translocate to the nucleus. The aim of this study was to analyse the expression and localization of the β-catenin-protein complex of the Wnt pathway in cells isolated from DF patients. METHODS AND RESULTS We isolated cells from biopsies of DF patients, and demonstrated, by immunofluorescence and immunoblot analyses, that it is almost exclusively nuclear GSK-3β that colocalizes and interacts with β-catenin. The nuclear translocation of β-catenin and GSK-3β is not correlated with CTNNB1 mutations. In DF samples, the multiprotein complex is disrupted, as the cytoplasmic localization of APC and axin makes interaction with the nuclear β-catenin and GSK-3β impossible. CONCLUSIONS Our data suggest that GSK-3β is an additional DF marker with an important role in the aetiopathogenesis of this entity.
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Cornelis F, Havez M, Lippa N, Al-Ammari S, Verdier D, Carteret T, Amoretti N, Gangi A, Palussiere J, Hauger O, Grenier N. Radiologically guided percutaneous cryotherapy for soft tissue tumours: A promising treatment. Diagn Interv Imaging 2013; 94:364-70. [PMID: 23491212 DOI: 10.1016/j.diii.2013.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies of percutaneous cryotherapy in the treatment of benign or malignant soft tissue tumours are rare and mainly involve small populations. Nevertheless, results show cryotherapy's potential in terms of local control of tumours, analgesic efficacy, reduced intra- and postoperative complications, and reduction in the length of convalescence after the procedure. The objective of this update is to set out the short-term prospects for this technique in the treatment of soft tissue tumours, so that it may be more widely offered in these indications.
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Affiliation(s)
- F Cornelis
- Adult Diagnostic and Interventional Imaging Department, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux, France.
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Cornelis F, Italiano A, Al-Ammari S, Kind M, Stoeckle E, Gangi A, Palussière J, Bui BN. Successful iterative percutaneous cryoablation of multiple extraabdominal desmoid tumors in a patient with Gardner syndrome. J Vasc Interv Radiol 2013; 23:1101-3. [PMID: 22840810 DOI: 10.1016/j.jvir.2012.05.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 11/25/2022] Open
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40
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[Huge retrovesical tumor as an incidental finding: desmoid-type fibromatosis: a case report]. Urologe A 2012; 52:74-8. [PMID: 22992890 DOI: 10.1007/s00120-012-2990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of a 57-year-old patient with a huge, retrovesical, aggressive desmoid fibromatosis detected incidentally during preoperative staging for radical prostatectomy. The tumor was locally invasive consisting of monoclonal and fibroblastic proliferations. The etiology of such tumors is not well known but they are mostly sporadic and aggressive fibromatosis is sometimes associated with familial adenomatous polyposis (FAP) or Gardner's syndrome. Such desmoid tumors are slow growing and locally invasive but lack metastatic potential. Complete resection with wide margins is the therapy of choice and the tendency to recur is high. Radiotherapy following surgery is controversial. We discuss the pathogenesis, clinical manifestations and therapy of such rare tumors.
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Mullen JT, Delaney TF, Kobayashi WK, Szymonifka J, Yeap BY, Chen YL, Rosenberg AE, Harmon DC, Choy E, Yoon SS, Raskin KA, Petur Nielsen G, Hornicek FJ. Desmoid tumor: analysis of prognostic factors and outcomes in a surgical series. Ann Surg Oncol 2012; 19:4028-35. [PMID: 22965569 DOI: 10.1245/s10434-012-2638-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Desmoid tumors are rare and exhibit a highly unpredictable natural history. We sought to analyze prognostic factors associated with recurrence in a large single-institution study of patients with desmoid tumors. METHODS We performed a retrospective review of 177 patients with desmoid tumor who underwent macroscopically complete surgical resection, with or without the addition of radiotherapy (RT) or systemic therapy, from 1970 to 2009. We examined patterns of presentation, all known risk factors for recurrence, and their association with recurrence-free survival (RFS). RESULTS Twenty-two patients (12 %) had intra-abdominal desmoid tumors, and 155 (88 %) had extra-abdominal tumors. Patterns of presentation included primary (n = 133, 75 %) and locally recurrent (n = 44, 25 %) disease. Treatment was surgery alone in 125 patients (71 %), surgery and RT in 36 (20 %), and surgery and systemic therapy with or without RT in 20 (11 %). Median follow-up was 40 months. Overall, the local relapse rate was 29 %, and 10-year RFS was 60 %. R0 resection status was the only predictor of freedom from local recurrence on multivariate analysis (odds ratio 0.32; 95 % confidence interval 0.15-0.66; P = 0.002). The selective use of adjuvant RT appeared to improve local control in patients with positive margins. CONCLUSIONS For patients with desmoid tumors undergoing surgery, wide excision with negative margins should be the goal, but not at the expense of function, as fewer than half of patients with positive margins will experience recurrence.
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Affiliation(s)
- John T Mullen
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
Fibroblastic and myofibroblastic tumors in children and adolescents are a relatively common group of soft tissue proliferations that range from reactive to hamartomatous to neoplastic, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic and immunohistochemical overlap, despite significant clinical, genetic, and prognostic differences. The fibromatoses are a major subgroup, and all types of fibromatoses can occur in the 1st 2 decades of life. Intermediate and malignant fibroblastic-myofibroblastic tumors are an important group that includes variants of fibrosarcoma and other tumors with recurrent cytogenetic or molecular genetic abnormalities and low metastatic potential. Pathologic examination is enhanced by adjunct techniques, such as immunohistochemistry, cytogenetics, and molecular genetics, although morphology provides the ultimate criteria for a specific diagnosis. This article reviews the clinicopathologic features of fibroblastic and myofibroblastic tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents, the use of diagnostic adjuncts, and differential diagnoses.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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Recurrence patterns and management options in aggressive fibromatosis. Indian J Surg Oncol 2012; 3:222-7. [PMID: 23997510 DOI: 10.1007/s13193-012-0146-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022] Open
Abstract
Aggressive fibromatosis is a rare neoplasm arising from musculoaponeurotic structures. Our aim is to share our experience with this rare tumor in our institute and to discuss the more perplexing recurrence patterns and the management options. This is a retrospective study of the disease, treated in our institute for the past fourteen years. A total of 36 patients were analyzed. The demographic pattern of the disease, various treatment modalities offered and their outcome along with patterns of recurrence were studied. Our study showed a demographic pattern mostly similar to the rest of the world. But the pattern of recurrence and the multicentric and the non-random pattern of presentation observed in our study showed some difference from the other studies. We suggest surgery as the primary modality with radiation reserved for select patients with margin positivity, inoperable tumors, and multiple tumors. Since the disease has a long natural history a wait and watch policy can be observed for giving adjuvant RT. There is need for prospective multi-institutional RCTs to shed light on the unknown facts about this disease.
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Mathew D, George RM, Jeba J, Varghese SS. Neuropathic Pain due to Fibromatosis: Does Anticancer Treatment Help? Indian J Palliat Care 2012; 17:245-7. [PMID: 22346052 PMCID: PMC3276825 DOI: 10.4103/0973-1075.92349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Desmoid fibromatosis, although histologically benign, infiltrates local structures. The involvement of neural structures can lead to difficult neuropathic pain and the escalating use of analgesics. We report a patient with desmoid fibromatosis of the chest wall causing brachial plexus infiltration. As the tumor was locally invasive and unresectable, he was treated with radiation therapy and oral tamoxifen. On follow-up, there was significant pain relief, sustained reduction in the tumor size, and reduced analgesic requirement. Antineoplastic treatments like local radiation therapy and targeted systemic therapy with hormones or other agents can be considered in the management of selected unresectable desmoid fibromatosis to improve symptom control and reduce polypharmacy.
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Affiliation(s)
- David Mathew
- Palliative Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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45
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Constantinidou A, Jones RL, Scurr M, Al-Muderis O, Judson I. Advanced aggressive fibromatosis: Effective palliation with chemotherapy. Acta Oncol 2011; 50:455-61. [PMID: 20799916 DOI: 10.3109/0284186x.2010.509105] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Aggressive fibromatosis (AF) is a locally invasive proliferative disease. The mainstay of treatment is surgery. Chemotherapy may be considered in inoperable AF following failure of hormonal therapy and/or NSAIDs. MATERIAL AND METHODS We conducted a retrospective search of the prospectively maintained Royal Marsden Hospital Sarcoma Unit database to identify patients with AF treated with chemotherapy between 1987 and 2009. RESULTS Thirty-nine patients, thirty one females and eight males, received one or more lines of chemotherapy. The most frequently employed chemotherapy regimens were methotrexate/vinblastine [MTX/VBL] (18) and pegylated liposomal doxorubicin [PLD] (14). MTX/VBL was administered weekly or every two weeks at MTX 50 mg and VBL 10 mg. Treatment duration ranged from three weeks to one year with a median of 4.5 months. Partial response (PR) was observed in 11% of cases, disease stabilisation (SD) in 60% and progressive disease (PD) in 22%. Time to progression ranged from one month to sixteen years. The main toxicities reported were mucositis (4), peripheral neuropathy (3), vomiting (3), and neutropenia (3). PLD was administered at 40-50 mg/m(2) every four weeks, for up to six cycles. PR was achieved in 33% and in the remainder the disease was stable with no progression during treatment. Three (25%) patients have so far progressed after treatment. Symptomatic benefit, especially pain relief, was reported in 86% (12/14) of cases. Main toxicities included palmar plantar erythema (5) and mucositis (4). DISCUSSION MTX/VBL remains a useful combination but PLD is emerging as a well tolerated and effective systemic therapy in advanced AF.
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Mankin HJ, Hornicek FJ, Springfield DS. Extra-abdominal desmoid tumors: a report of 234 cases. J Surg Oncol 2010; 102:380-4. [PMID: 19877160 DOI: 10.1002/jso.21433] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND/OBJECTIVES To report on the clinical presentation and outcome for 234 patients with extra-abdominal desmoids tumors. METHODS Since 1977, the authors have treated 234 patients with extra-abdominal desmoid tumors. The patients had an average age of 36.7 and 61% were female. The tumors arose adjacent to muscles or bones and the largest number were in the foot, shoulder thigh and calf. All of the patients were treated by primary surgery. Thirty-seven had additional radiation and eight had chemotherapy. RESULTS Local recurrence occurred in 39 patients and 23% of the patients required additional surgery. Of great concern were 24 patients who developed multiple sites metachronously, which required further surgery and in many cases caused disability. None of the patients died of disease but 5 required amputations. CONCLUSIONS The authors concluded that despite the benign nature of the disease, these patients are difficult to treat and the results are sometimes considerably less than optimal.
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Affiliation(s)
- Henry J Mankin
- Orthopaedic Oncology Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. hmankin @partners.org
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de Camargo VP, Keohan ML, D'Adamo DR, Antonescu CR, Brennan MF, Singer S, Ahn LS, Maki RG. Clinical outcomes of systemic therapy for patients with deep fibromatosis (desmoid tumor). Cancer 2010; 116:2258-65. [PMID: 20187095 DOI: 10.1002/cncr.25089] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the current study, the authors examined the outcomes of patients with desmoid tumors who received systemic therapy at a single institution to provide a basis for the examination of newer agents. METHODS Records of patients with desmoid tumors who were treated with chemotherapy at the study institution were reviewed. The activity of nonsteroidal anti-inflammatory drugs was not addressed. Patients without measurable disease and those receiving therapy could not be documented, and those receiving prophylactic therapy were excluded. RESULTS A total of 68 patients received 157 lines of therapy. At the time of last follow-up, 9 patients had died, 7 of progressive disease. The cohort was 62% female, with a median age of 32.5 years. Approximately 32% of the patients had Gardner syndrome. The median follow-up was 63 months, and patients received a median of 2 lines of therapy. An intra-abdominal primary tumor location was the most common (44%). The greatest Response Evaluation Criteria in Solid Tumors (RECIST) response rate was observed with anthracyclines and hormonal therapy and the lowest response was noted with single-agent dacarbazine/temozolomide or tyrosine kinase inhibitors, principally imatinib. On multivariate analysis, macroscopic nodular morphology and the presence of Gardner syndrome were the only tumor factors found to be associated with a greater time to disease progression. CONCLUSIONS Compared with other agents, antiestrogens and anthracycline-containing regimens appear to be associated with a higher radiological response rate against desmoid tumors. Systemic therapy can be successful in patients with desmoid tumors, and is a viable option in lieu of morbid or disabling surgery.
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The surgical management of soft tissue tumours arising in the abdominal wall. Eur J Surg Oncol 2010; 36:489-95. [DOI: 10.1016/j.ejso.2010.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/15/2010] [Accepted: 03/18/2010] [Indexed: 12/22/2022] Open
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A V530I Mutation in c-KIT Exon 10 Is Associated to Imatinib Response in Extraabdominal Aggressive Fibromatosis. Sarcoma 2010; 2010:458156. [PMID: 20339585 PMCID: PMC2841250 DOI: 10.1155/2010/458156] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/04/2010] [Accepted: 01/25/2010] [Indexed: 11/30/2022] Open
Abstract
Aggressive fibromatosis (AF) or desmoid tumor is a rare condition, characterized by deep tissue invasion by a monoclonal fibroblastic neoplasm, developed from musculoaponeurotic structures. Surgery is the treatment of choice, but negative margins can hardly been achieved in large tumors, and can lead to major functional disability. AF medical therapy includes nonsteroids anti-inflammatory drugs, tamoxifen, with inconsistent results. Several reports of imatinib efficacy in AF appear in the literature. Here, we describe for the first time a V530I KIT exon 10 mutant that was associated to a dramatic imatinib response in an extraabdominal aggressive fibromatosis. The previously discovered V530I substitution was characterized in the core binding factor AML, but had never been reported in any other condition, so far. In this paper, we discuss the KIT exon 10 mutations or polymorphisms that have been described in a variety of KIT-related conditions, including acute myelogenous leukemia, mastocytosis, and aggressive fibromatosis.
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Joyner DE, Trang SH, Aboulafia AJ, Damron TA, Randall RL. FAP-associated desmoid invasiveness correlates with in vitro resistance to doxorubicin. Fam Cancer 2010; 8:569-80. [PMID: 19728161 DOI: 10.1007/s10689-009-9288-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Desmoid tumors are locally invasive myofibroblastic lesions that arise predominantly in the abdominal wall or shoulder girdle and are prone to aggressive local recurrences without metastases. We hypothesized the intrinsic invasiveness and drug resistance displayed by cells derived from a familial adenomatous polyposis (FAP)-associated desmoid tumor would surpass the response shown by cells derived from sporadic desmoid tumors. In vitro cell motility and expression of motility-associated genes were quantified using Boyden Chambers and Enzyme-Linked ImmunoSorbent Assays, respectively. Doxorubicin resistance was quantified by Trypan Blue dye exclusion. cDNA microarrays identified genes responsive to doxorubicin. FAP-associated tumor cells were significantly more invasive and refractory to doxorubicin than were cells extracted from sporadic tumors. Pro-MMP1 protein predominated over MMP3 in FAP-associated cell culture supernatants, while MMP3 was the dominant antigen in sporadic tumor cell supernatants. Three genes associated with apoptosis were identified by microarray, two prosurvival genes overexpressed in FAP-associated cell cultures (NTN1, TNFRSF10C) and one proapoptosis gene overexpressed in sporadic tumor cell cultures (FOXL2).
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Affiliation(s)
- David E Joyner
- Department of Orthopaedics, Sarcoma Services, SARC Laboratory, and Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
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