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Schoettler PJ, Smith CC, Nishitani M, Harris AK, Nelson AT, Watson DA, Kamihara J, Mullen EA, Hill DA, Messinger YH, Fair DB, Kumar KA, Dehner LP, Ash S, Chen KS, Schultz KAP. Anaplastic sarcoma of the kidney (DICER1-sarcoma of the kidney): A report from the International Pleuropulmonary Blastoma/DICER1 Registry. Pediatr Blood Cancer 2024; 71:e31090. [PMID: 38807260 DOI: 10.1002/pbc.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Anaplastic sarcoma of the kidney (ASK) is a DICER1-related neoplasm first identified as a distinctive tumor type through the evaluation of unusual cases of putative anaplastic Wilms tumors. Subsequent case reports identified the presence of biallelic DICER1 variants as well as progression from cystic nephroma, a benign DICER1-related neoplasm. Despite increasing recognition of ASK as a distinct entity, the optimal treatment remains unclear. METHODS Individuals with known or suspected DICER1-related tumors including ASK were enrolled in the International Pleuropulmonary Blastoma/DICER1 Registry. Additionally, a comprehensive review of reported cases of ASK was undertaken, and data were aggregated for analysis with the aim to identify prognostic factors and clinical characteristics to guide decisions regarding genetic testing, treatment, and surveillance. RESULTS Ten cases of ASK were identified in the Registry along with 37 previously published cases. Staging data, per Children's Oncology Group guidelines, was available for 40 patients: 13 were stage I, 12 were stage II, 10 were stage III, and five were stage IV. Outcome data were available for 37 patients. Most (38 of 46) patients received upfront chemotherapy and 14 patients received upfront radiation. Two-year event-free survival (EFS) for stage I-II ASK was 81.8% (95% confidence interval [CI]: 67.2%-99.6%), compared with 46.6% EFS (95% CI: 24.7%-87.8%) for stage III-IV (p = .07). Two-year overall survival (OS) for stage I-II ASK was 88.9% (95% CI: 75.5%-100.0%), compared with 70.0% (95% CI: 46.7%-100.0%) for stage III-IV (p = .20). Chemotherapy was associated with improved EFS and OS with hazard ratios of 0.09 (95% CI: 0.02-0.31) and 0.08 (95% CI: 0.02-0.42), respectively. CONCLUSION ASK is a rare DICER1-related renal neoplasm. In the current report, we identify clinical and treatment-related factors associated with outcome including the importance of chemotherapy in treating ASK. Ongoing data collection and genomic analysis are indicated to optimize outcomes for children and adults with these rare tumors.
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Affiliation(s)
- Peter J Schoettler
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics and Adolescent Medicine, Division of Hematology-Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline C Smith
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Miki Nishitani
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne K Harris
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Alexander T Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Dave A Watson
- Research Institute, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Junne Kamihara
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - D Ashley Hill
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, Missouri, USA
| | - Yoav H Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Douglas B Fair
- Department of Pediatrics, Division of Hematology/Oncology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - Kiran A Kumar
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis P Dehner
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, Missouri, USA
| | - Shifra Ash
- Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kenneth S Chen
- Department of Pediatrics, Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kris Ann P Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children's Minnesota, Minneapolis, Minnesota, USA
- Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
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Kroll-Wheeler L, Heider A. Anaplastic Sarcoma of the Kidney With Heterologous Ganglioneuroblastic Differentiation: Another DICER1-Associated Tumor. Pediatr Dev Pathol 2022; 25:186-191. [PMID: 34515577 DOI: 10.1177/10935266211043861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Anaplastic sarcoma of the kidney (ASK) is a rare renal tumor for which less than thirty cases have been described in the literature to date. Diagnosis of ASK is primarily based on histology, which features solid spindle cell neoplastic islands arranged in a fascicular pattern, prominent anaplastic nuclear morphology, brisk mitoses, and multiple multiloculated cysts lined by hobnail epithelium reminiscent of cystic nephroma. Chondroid or rhabdomyocytic differentiation is often present within the sarcoma. It has been recently suggested that this tumor entity belongs to the DICER1 syndrome tumors based on identification of DICER1 mutations. We report on a case of this rare tumor found in a twenty-month-old female. In addition to the typical histologic findings of ASK, this case also displayed heterologous neuroblastic-gangliocytic differentiation, which has not been previously described in the literature. TP53 and BRAF v600E had aberrant immunostaining. Chromosomal microarray and genomic sequencing revealed loss of chromosome 10 p15.3-p11.2 and both somatic and germline DICER1 mutations, consistent with recent research and further supporting the classification of this tumor within the DICER1 syndrome associated tumors.
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Affiliation(s)
| | - Amer Heider
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
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Yamaoka T, Haga Y, Tochigi N, Yoshida M, Takahashi H. Anaplastic sarcoma of the kidney with DICER1 mutation: A case report. Pediatr Int 2022; 64:e14851. [PMID: 34897882 DOI: 10.1111/ped.14851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/15/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Tatsuhiro Yamaoka
- Department of Pediatrics, Toho University Omori Medical Center, Ota-ku, Japan
| | - Yoichi Haga
- Department of Pediatrics, Toho University Omori Medical Center, Ota-ku, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Japan
| | - Masanori Yoshida
- Children's Cancer Center, National Center for Child Health and Development, Ota-ku, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pediatrics, Toho University Omori Medical Center, Ota-ku, Japan
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Kao JL, Tsung SH, Shiao CC. Rare anaplastic sarcoma of the kidney: A case report. World J Clin Cases 2020; 8:1495-1501. [PMID: 32368542 PMCID: PMC7190953 DOI: 10.12998/wjcc.v8.i8.1495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/29/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anaplastic sarcoma of the kidney (ASK) is a rare and newly recognized renal neoplasm. The tumor usually is extensive and cystic, characterized by pleomorphic spindle cells with marked atypia and associated with multinucleated cells. To date, only 27 cases have been reported in the literature. The authors present an additional case and summarize the relevant knowledge in the literature.
CASE SUMMARY A 27-year-old previously healthy woman presented with a palpable mass over the abdomen and right flank soreness for one year. After the computed tomography study, the patient underwent right radical nephrectomy obtaining a 1680-g tumor with a size of 18.4 cm × 14.5 cm × 11 cm. The tumor is chiefly composed of anaplastic spindle cells with marked nuclear atypia admixed with multinucleated cells. Immunohistochemical evaluation of tumor cells exhibited diffuse positivity for CD56, p53, and vimentin, and focally positive for desmin. The diagnosis of ASK was established. Unfortunately, a local tumor recurrence followed by a distant metastasis developed within months. The patient died 26 months after the initial surgery. Comparing to the previously 27 cases of ASK, the current case had a relatively worse prognosis, which might be potentially associated with older patient age, larger tumor size, and the lack of en-bloc resection of adjacent organs during the initial radical nephrectomy.
CONCLUSION This case points out the featured pathological findings for diagnosing ASK and suggests more aggressive management for patients with ASK.
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Affiliation(s)
- Jsun-Liang Kao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Yilan 26546, Taiwan
| | - Swei-Hsiung Tsung
- Department of Pathology, Camillian Saint Mary’s Hospital Luodong, Yilan 26546, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Yilan 26546, Taiwan
- Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan 26546, Taiwan
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Abstract
We present a case of a 22-year-old female with gross hematuria for 1 month. A 9.5-cm tumor was found at her left kidney. On suspicion of a renal cancer, she received left nephrectomy. Histologically, it was a hypercellular tumor with undifferentiated anaplastic neoplastic cells in fascicular sheets intermixed with chondroid nodules. The differential diagnoses included anaplastic sarcoma of the kidney (ASK), anaplastic Wilms tumor, mesenchymal chondrosarcoma, sarcomatoid renal cell carcinoma, clear cell sarcoma of the kidney, rhabdoid tumor of the kidney, congenital mesoblastic nephroma, and synovial sarcoma. Based on the results of the work-up and literature review, ASK was diagnosed. The postoperative recovery was uneventful, and the patient began adjuvant chemotherapy (Ifosfamide [1800 mg/m2] and Epirubicin [60 mg/m2]) 5 weeks after the operation. Herein, we present this case to share the experience on an extremely rare entity.
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Affiliation(s)
- Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kai-Sheng Liao
- Department of Pathology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Nursing, Chung-Jen College of Nursing, Health Sciences and Management, Chiayi, Taiwan
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Anaplastic sarcomas of the kidney are characterized by DICER1 mutations. Mod Pathol 2018; 31:169-178. [PMID: 28862265 DOI: 10.1038/modpathol.2017.100] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/11/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022]
Abstract
Anaplastic sarcoma of the kidney is a rare tumor (≤25 reported cases) characterized by the presence of cysts, and solid areas composed of bundles of undifferentiated spindle cells, showing marked cellular anaplasia (usually accompanied by TP53 overexpression). These tumors often feature prominent areas of cartilage or chondroid material. Germline mutations in DICER1, encoding the microRNA (miRNA) processor DICER1, cause an eponymous syndrome. Recent reports suggest that anaplastic sarcoma of the kidney should be included in DICER1 syndrome as germline DICER1 mutations are associated with the occurrence of such tumors. Therefore, we sought to determine the following: (1) what proportion of anaplastic sarcoma of the kidney have DICER1 mutations; (2) whether the identified mutations affect both alleles of DICER1 (ie, are biallelic); (3) whether somatic missense mutations in the DICER1 RNase IIIb domain impact miRNA generation; and (4) whether TP53 alteration always occurs in these tumors. DICER1 mutations were evaluated by Sanger sequencing and next-generation sequencing in nine tumor/normal pairs. Impact of DICER1 mutations on miRNA generation was evaluated via an in vitro DICER1 cleavage assay. TP53 status was assessed by immunohistochemistry and next-generation sequencing. Eight of the nine cases had at least one RNase IIIb DICER1 mutation that impacted the generation of miRNAs. There were six tumors with truncating DICER1 mutations and in four of them, the mutation found in the tumor was also detected in adjacent normal tissue, and therefore was likely to be either mosaic or germline in origin. Analysis of mutation phase revealed that two of three tumors had biallelic DICER1 mutations. Six of nine anaplastic sarcomas of the kidney had aberrant TP53 immunohistochemisty with damaging TP53 mutations identified in three cases. Taken together, these data suggest that the great majority of anaplastic sarcomas of the kidney have DICER1 mutations and confirm that these tumors are part of the DICER1 syndrome.
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7
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Polyphenotypic Anaplastic Sarcoma of the Kidney: A Rare Case Report and Review of the Literature. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.59541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Arabi H, Al-Maghraby H, Yamani A, Yousef Y, Huwait H. Anaplastic Sarcoma of the Kidney: A Rare Unique Renal Neoplasm. Int J Surg Pathol 2016; 24:556-61. [PMID: 27006300 DOI: 10.1177/1066896916639373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anaplastic sarcoma of the kidney (ASK) is an extremely rare tumor, which usually presents as a large renal mass. Microscopically, the tumor is composed of pleomorphic mesenchymal spindle cells with marked atypia, associated with chondroid differentiation and focal round primitive mesenchymal cells. Herein, we present a case of anaplastic sarcoma of the kidney in a 3-year-old female, who presented with a large abdominal mass. To the best of our knowledge, less than 25 cases are reported in the literature. In addition, this is the first case reported from the Middle East.
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Affiliation(s)
- Haitham Arabi
- Department of Pathology and Lab Medicine, King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, King Khaled National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hatim Al-Maghraby
- Department of Pathology and Lab Medicine, King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, King Khaled National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Arwa Yamani
- Department of Pediatric Hematology Oncology, King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, King Khaled National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Yasmin Yousef
- Department of Pediatric Surgery, King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, King Khaled National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hassan Huwait
- Department of Pathology and Lab Medicine, King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, King Khaled National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Malkan AD, Loh A, Bahrami A, Navid F, Coleman J, Green DM, Davidoff AM, Sandoval JA. An approach to renal masses in pediatrics. Pediatrics 2015; 135:142-58. [PMID: 25452658 DOI: 10.1542/peds.2014-1011] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Renal masses in children may be discovered during routine clinical examination or incidentally during the course of diagnostic or therapeutic procedures for other causes. Renal cancers are rare in the pediatric population and include a spectrum of pathologies that may challenge the clinician in choosing the optimal treatment. Correct identification of the lesion may be difficult, and the appropriate surgical procedure is paramount for lesions suspected to be malignant. The purpose of this article is to provide a comprehensive overview regarding the spectrum of renal tumors in the pediatric population, both benign and malignant, and their surgical management.
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Affiliation(s)
| | | | | | - Fariba Navid
- Oncology, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Daniel M Green
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee; and
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Öztürk H. Prognostic features of renal sarcomas (Review). Oncol Lett 2014; 9:1034-1038. [PMID: 25663853 PMCID: PMC4315065 DOI: 10.3892/ol.2014.2838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022] Open
Abstract
The aim of the present review was to evaluate the prognostic features of primary sarcomas of the kidney. A literature review was conducted using a number of databases, including Medline (PubMed) and Scopus, for studies published between January 1992 and December 2013. Of the studies published in English, those describing the prognostic features of primary sarcomas of the kidney were recorded. The electronic search was limited to the following keywords: Sarcoma, renal sarcoma, prognosis, diagnosis, immunohistochemistry, genetic and survey. Subsequent to the search, no review articles and/or meta-analyses associated with the prognosis of primary sarcomas of the kidney were identified. In total, 31 studies, which consisted of case studies, case series and studies concerned with the overall prognosis of urological soft-tissue sarcomas, were reviewed. Primary sarcoma of the kidney has a poor prognosis compared with other sarcomas of the urogenital system. In addition to the surgical excision of renal sarcomas, pathological, molecular and genetic prognostic factors are also considered. Due to the small number of cases, previous studies have not randomized the prognostic features of primary sarcomas of the kidney. The elucidation of the so-called ‘chaotic’ genetic and molecular basis of renal sarcomas will help to predict patient prognoses. Surgical excision is the most significant parameter for determining the prognosis of sarcomas of the kidney. However, sarcomas also exhibit prognostic features that are based upon pathological, genetic and molecular factors. The present review suggests that additional factors may be important in predicting the prognosis of patients with renal sarcomas, and that clinicians should plan treatment and follow-up regimens according to these factors.
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, School of Medicine, Sifa University, Izmir 35240, Turkey
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