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Brodsky CN, Bucala MD, Abdulfatah EM, Siegel GW. Extraskeletal Myxoid Chondrosarcoma: Retrospective Case Series Examining Prognostic Factors, Treatment Approaches, and Oncologic Outcomes. Am J Clin Oncol 2023; 46:172-177. [PMID: 36825763 DOI: 10.1097/coc.0000000000000988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Extraskeletal myxoid chondrosarcoma (EMC) is an ultrarare soft tissue sarcoma, and a limited number of studies are published regarding its clinical course and efficacy of treatment. The goal of this retrospective case series is to explore patient characteristics, treatment approaches, and oncologic outcomes to help inform future EMC management. METHODS All patients with a diagnosis of EMC seen at the University of Michigan Sarcoma Center between 1998 and 2021 were identified. A chart review was performed to analyze demographics, tumor characteristics, treatments, and outcomes. RESULTS Forty-four patients with EMC were identified. The median follow-up was 49.8 months. The median age at diagnosis was 57 (range: 25 to 79), and 35 patients (80%) were male. Thirty-four patients (77%) had locoregional disease at diagnosis, and 26 patients (59%) ultimately developed metastatic disease. After locoregional curative-intent surgery, 15 patients had documented recurrence, of which 11 were metastatic (73%). Five-year overall survival was 79% for all patients, 86% for locoregional disease, and 58% for metastatic disease; for locoregional disease, 5-year disease-free and metastasis-free survival post-surgery were 43% and 53%, respectively; 1-year progression-free survival for metastatic disease from the start of first-line systemic therapy was 43%. Older age was the only factor statistically associated with improved prognosis, although perioperative radiotherapy, lower histologic grade, and negative margins also had directional associations with outcomes. CONCLUSIONS The data in this patient series are generally consistent with published literature on EMC and demonstrate a high recurrence rate, high propensity for metastasis, and high rate of progression of metastatic disease on systemic therapy.
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Honda Y, Katagiri H, Onoe T, Aramaki T. Extraskeletal myxoid chondrosarcoma in the pelvis successfully treated with proton beam radiotherapy. BMJ Case Rep 2023; 16:e250218. [PMID: 36720511 PMCID: PMC9890794 DOI: 10.1136/bcr-2022-250218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The standard treatment for extraskeletal myxoid chondrosarcoma is wide excision. However, extraskeletal myxoid chondrosarcoma is often located in the deep layers of the extremities and pelvis, so functional impairment due to wide resection is unavoidable in many cases. In addition, the efficacy of radiotherapy and chemotherapy has not been defined, so no treatment method is established for unresectable cases. Here we report a case involving a man in his late 60s with extraskeletal myxoid chondrosarcoma of the pelvis who responded to proton beam radiotherapy with intra-arterial chemotherapy and did not require surgery. The patient maintained a complete response for more than 7 years. The findings from this case suggest that definitive irradiation can be an alternative to wide resection for cases of extraskeletal myxoid chondrosarcoma in which severe disability cannot be avoided after resection or when the tumour is inoperable due to its size and location.
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Affiliation(s)
- Yosuke Honda
- Orthopedics, Hamamatsu Red Cross Hospital, Hamamatsu, Shizuoka, Japan
- Orthopedic Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Hirohisa Katagiri
- Orthopedic Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Tsuyoshi Onoe
- Radiation and Proton Therapy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Takeshi Aramaki
- Interventional Radiology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
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Bangerter JL, Harnisch KJ, Chen Y, Hagedorn C, Planas-Paz L, Pauli C. Establishment, characterization and functional testing of two novel ex vivo extraskeletal myxoid chondrosarcoma (EMC) cell models. Hum Cell 2023; 36:446-455. [PMID: 36316541 PMCID: PMC9813045 DOI: 10.1007/s13577-022-00818-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 11/04/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a malignant mesenchymal neoplasm of uncertain differentiation as classified by the WHO Classification of Tumours 2020. Although often associated with pronlonged survival, EMC has high rates of distant recurrences and disease-associated death. EMCs are translocation sarcomas and harbor in > 90% of the cases an NR4A3 rearrangement. The molecular consequences of the NR4A3 gene fusions are not yet fully elucidated as well-characterized ex vivo cell models for EMC are lacking. Patient-derived ex vivo models are important and essential tools for investigating disease mechanisms associated with diseases that are rare, that exhibit poor prognosis and for the identification of potential novel treatment options. We established two novel EMC ex vivo models (USZ20-EMC1 and USZ22-EMC2) for functional testing and research purposes. USZ20-EMC1 and USZ22-EMC2 were established and maintained as sarco-sphere cell models for several months in culture. The cells were molecularly characterized using DNA sequencing and methylation profiling. Both cell models represent their native tumor tissue as confirmed by histomorphology and their molecular profiles, suggesting that native tumor cell function can be recapitulated in the ex vivo models. Using a functional screening approach, novel anti-cancer drug sensitivities including potential synergistic combinations were identified. In conclusion, two novel EMC ex vivo cell models (USZ20-EMC1 and USZ22-EMC2) were successfully established and characterized from native tumor tissues. Both cell models will be useful tools for further investigating disease mechanisms and for answering basic and translational research questions.
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Affiliation(s)
- Jana Lucia Bangerter
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Kim Jannis Harnisch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Yanjiang Chen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Catherine Hagedorn
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Lara Planas-Paz
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland
| | - Chantal Pauli
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8006, Zurich, Switzerland.
- Medical Faculty, University of Zurich, Zurich, Switzerland.
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Receptor Tyrosine Kinase Inhibitors for the Treatment of Recurrent and Unresectable Bone Sarcomas. Int J Mol Sci 2022; 23:ijms232213784. [PMID: 36430263 PMCID: PMC9697271 DOI: 10.3390/ijms232213784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Bone sarcomas are a heterogeneous group of rare tumors with a predominance in the young population. Few options of systemic treatment are available once they become unresectable and resistant to conventional chemotherapy. A better knowledge of the key role that tyrosine kinase receptors (VEGFR, RET, MET, AXL, PDGFR, KIT, FGFR, IGF-1R) may play in the pathogenesis of these tumors has led to the development of multi-target inhibitors (TKIs) that are progressively being incorporated into our therapeutic arsenal. Osteosarcoma (OS) is the most frequent primary bone tumor and several TKIs have demonstrated clinical benefit in phase II clinical trials (cabozantinib, regorafenib, apatinib, sorafenib, and lenvatinib). Although the development of TKIs for other primary bone tumors is less advanced, preclinical data and early trials have begun to show their potential benefit in advanced Ewing sarcoma (ES) and rarer bone tumors (chondrosarcoma, chordoma, giant cell tumor of bone, and undifferentiated pleomorphic sarcoma). Previous reviews have mainly provided information on TKIs for OS and ES. We aim to summarize the existing knowledge regarding the use of TKIs in all bone sarcomas including the most recent studies as well as the potential synergistic effects of their combination with other systemic therapies.
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Gusho CA, King D, Ethun CG, Cardona K, Harrison Howard J, Tran TB, Poultsides G, Tseng J, Roggin KK, Fields RC, Cullinan DR, Chouliaras K, Votanopoulos K, Grignol VP, Bedi M. Extraskeletal myxoid chondrosarcoma: Clinicopathological features and outcomes from the United States sarcoma collaborative database. J Surg Oncol 2022; 126:1533-1542. [PMID: 35962783 DOI: 10.1002/jso.27062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUNDS AND OBJECTIVES This investigation described clinicopathological features and outcomes of extraskeletal myxoid chondrosarcoma (EMC) patients. METHODS EMC patients were identified from the United States Sarcoma Collaborative database between 2000 and 2016. Overall survival (OS) and recurrence-free survival (RFS) were calculated, and prognostic factors were analyzed. RESULTS Sixty individuals with a mean age of 55 years were included, and 65.0% (n = 39) were male. 73.3% (n = 44) had a primary tumor. A total of 41.6% (n = 25) developed tumor relapse following resection. The locoregional recurrence rate was 30.0% (n = 18/60), and mean follow-up was 42.7 months. The 5-year OS was 71.0%, while the 5-year RFS was 41.4%. On multivariate analysis for all EMC, chemotherapy (hazard ratio [HR], 6.054; 95% confidence interval [CI], 1.33-27.7; p = 0.020) and radiation (HR, 5.07, 95% CI, 1.3-20.1; p = 0.021) were independently predictive of a worse RFS. Among patients with primary EMC only, the 5-year OS was 85.3%, with a 30.0% (n = 12) locoregional recurrence rate, though no significant prognostic factors were identified. CONCLUSIONS Long-term survival with EMC is probable, however there exists a high incidence of locoregional recurrence. While chemotherapy and radiation were associated with a worse RFS, these findings were likely confounded by recurrent disease as significance was lost in the primary EMC-only subset.
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Affiliation(s)
| | - David King
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - J Harrison Howard
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, CA, USA
| | | | | | | | - Ryan C Fields
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | | - Valerie P Grignol
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Wilbur HC, Robinson DR, Wu YM, Kumar-Sinha C, Chinnaiyan AM, Chugh R. Identification of Novel PGR-NR4A3 Fusion in Extraskeletal Myxoid Chondrosarcoma and Resultant Patient Benefit From Tamoxifen Therapy. JCO Precis Oncol 2022; 6:e2200039. [PMID: 36103645 PMCID: PMC9489176 DOI: 10.1200/po.22.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/24/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- H. Catherine Wilbur
- Department of Medicine, Division of Hematology and Oncology, and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Dan R. Robinson
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Chandan Kumar-Sinha
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan School of Medicine, Ann Arbor, MI
- Department of Pathology and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
| | - Rashmi Chugh
- Department of Medicine, Division of Hematology and Oncology, and Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI
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Zhu ZY, Wang YB, Li HY, Wu XM. Primary intracranial extraskeletal myxoid chondrosarcoma: A case report and review of literature. World J Clin Cases 2022; 10:4301-4313. [PMID: 35665108 PMCID: PMC9131214 DOI: 10.12998/wjcc.v10.i13.4301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/04/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary intracranial extraskeletal myxoid chondrosarcoma (EMC) is an extremely rare low- to intermediate-grade malignant soft tissue sarcoma, and only 15 cases have been reported in the literature. Due to its rarity, clinical data and research on this tumor type are extremely limited, the pathogenesis and histological origin are still unclear, and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined.
CASE SUMMARY We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo, and his health status deteriorated during the last week. CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus. Brain magnetic resonance imaging (MRI) showed a 3.4 cm × 3.0 cm sized, well-defined, round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus. The entire lesion was removed via supratentorial craniotomy and microsurgery. Postoperative pathological diagnosis indicated primary intracranial EMC. Subsequently, the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge. At present, it is 12 mo after surgery, with regular postoperative follow-up and regular MRI examinations, that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor, and the patient has returned to normal life.
CONCLUSION Currently, the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy. Long-term follow-up is also necessary for patients.
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Affiliation(s)
- Zi-You Zhu
- Department of Neurosurgery, The First Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
| | - Yu-Bo Wang
- Department of Neurosurgery, The First Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
| | - Han-Yi Li
- Department of Orthodontics, Hospital of Stomatology of Jilin University, Changchun 130021, Jilin Province, China
| | - Xin-Min Wu
- Department of Neurosurgery, The First Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
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Single-Center Experience with Trabectedin for the Treatment of Non-L-sarcomas. Adv Ther 2022; 39:1596-1610. [PMID: 35129790 DOI: 10.1007/s12325-022-02051-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The effectiveness of trabectedin for the treatment of leiomyosarcoma and liposarcoma (commonly referred to as L-sarcomas) has been widely evidenced in clinical trials and real-world studies. Nevertheless, available literature on non-L-sarcomas is less abundant. The objective of the present study is to evaluate the effectiveness and safety of trabectedin in a cohort of patients with non-L-sarcomas in the real-world setting. METHODS This retrospective, observational study included 34 patients who received trabectedin in the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) between October 2013 and July 2020. RESULTS The most frequent histologic subtypes were undifferentiated spindle cell/pleomorphic sarcoma (n = 11, 32.4%), synovial sarcoma (n = 6, 17.7%), myxofibrosarcoma (n = 5, 14.7%), and malignant peripheral nerve sheath tumor (n = 4, 11.8%). The mean number of cycles with trabectedin was 5.5 (range 2-28). Three patients achieved partial response (8.8%) and eight patients showed stable disease (23.5%). The objective response rate and disease control rate were 8.8% (95% confidence interval (CI), 95% CI 1.9-23.7) and 32.4% (95% CI 17.4-50.5), respectively. Overall, progression-free survival was 2.9 months (95% CI 2.1-3.4). The overall survival was 7.3 months (95% CI 4.7-12.8). The most common trabectedin-related grade 3 adverse events were observed in 10 patients (26.5%), mostly being neutropenia (14.7%) and elevated transaminases (5.9%), whereas one patient (2.9%) reported grade 4 febrile neutropenia that required hospitalization. CONCLUSIONS The findings of this real-life study consistently support that trabectedin is an effective and safe option for the treatment of patients with non-L-sarcoma after failure of anthracyclines and ifosfamide, or in patients who are unsuited to receive these agents.
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Uncommon and peculiar soft tissue sarcomas: Multidisciplinary review and practical recommendations. Spanish Group for Sarcoma research (GEIS -GROUP). Part II. Cancer Treat Rev 2021; 99:102260. [PMID: 34340159 DOI: 10.1016/j.ctrv.2021.102260] [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: 04/18/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Among all Soft Tissue sarcomas there are some subtypes with low incidence and/or peculiar clinical behaviour, that need to be consider separately. Most of them are orphan diseases, whose biological characteristics imply a clearly different diagnostic and therapeutic approach from other more common sarcoma tumors. We present a brief and updated multidiciplinary review, focused on practical issues, aimed at helping clinicians in decision making. In this second part we review these subtypes: Alveolar Soft Part Sarcoma, Epithelioid Sarcoma, Clear Cell Sarcoma, Desmoplastic Small Round Cell Tumor, Rhabdoid Tumor, Phyllodes Tumor, Tenosynovial Giant Cell Tumors, Myoepithelial Tumor, Perivascular Epithelioid Cell Neoplasms (PEComas), Extraskeletal Myxoid Chondrosarcoma, NTRK-fusions Sarcomas. Most of them present their own radiological and histopathological feautures, that are essential to know in order to achieve early diagnosis. In some of them, molecular diagnosis is mandatory, not only in the diagnosis, but also to plan the treatment. On the other hand, and despite the low incidence, a great scientific research effort has been made to achieve new treatment opportunities for these patients even with approved indications. These include new treatments with targeted therapies and immunotherapy, which today represent possible therapeutic options. It is especially important to be attentive to new and potential avenues of research, and to promote the conduct of specific clinical trials for rare sarcomas.
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Stacchiotti S, Baldi GG, Morosi C, Gronchi A, Maestro R. Extraskeletal Myxoid Chondrosarcoma: State of the Art and Current Research on Biology and Clinical Management. Cancers (Basel) 2020; 12:cancers12092703. [PMID: 32967265 PMCID: PMC7563993 DOI: 10.3390/cancers12092703] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The aim of this review is to provide an overview of the biological basis of pathogenesis and current research in extraskeletal myxoid chondrosarcoma (EMC), together with the state of the art of treatment for localized and advanced disease. EMC is an ultra-rare sarcoma sub-type, more often arising from the soft tissues, marked by specific molecular features consisting in rearrangement of the NR4A3 gene, identified in recent years and very useful to distinguish EMC from other mimics. Available pharmacological treatments in particular are discussed, with a focus on the most recent results and future perspectives. Abstract Extraskeletal myxoid chondrosarcoma (EMC) is an ultra-rare mesenchymal neoplasm with uncertain differentiation, which arises mostly in the deep soft tissue of proximal extremities and limb girdles. EMC is marked by a translocation involving the NR4A3 gene, which can be fused in-frame with different partners, most often EWSR1 or TAF1. Although EMC biology is still poorly defined, recent studies have started shedding light on the specific contribution of NR4A3 chimeric proteins to EMC pathogenesis and clinical outcome. Standard treatment for localized disease is surgery, plus or minus radiation therapy with an expected prolonged survival even though the risk of relapse is about 50%. In advanced cases, besides the standard chemotherapy currently used for soft tissue sarcoma, antiangiogenic agents have recently shown promising activity. The aim of this review is to provide the state of the art of treatment for localized and advanced disease, with a focus on pharmacological treatments available for EMC. The biological basis of current research and future perspectives will be also discussed.
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Affiliation(s)
- Silvia Stacchiotti
- Medical Oncology Unit 2, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2390-2803; Fax: +39-02-2390-2804
| | - Giacomo Giulio Baldi
- “Sandro Pitigliani” Medical Oncology Department, Hospital of Prato, 59100 Prato, Italy;
| | - Carlo Morosi
- Deparment of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Roberta Maestro
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, 33081 Aviano, Italy;
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Paioli A, Stacchiotti S, Gronchi A. ASO Author Reflections: Extraskeletal Myxoid Chondrosarcoma: A Rare Sarcoma Associated With Prolonged Survival. Ann Surg Oncol 2020; 27:797-798. [PMID: 32607606 DOI: 10.1245/s10434-020-08774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Silvia Stacchiotti
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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12
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Paioli A, Stacchiotti S, Campanacci D, Palmerini E, Frezza AM, Longhi A, Radaelli S, Donati DM, Beltrami G, Bianchi G, Barisella M, Righi A, Benini S, Fiore M, Picci P, Gronchi A. Extraskeletal Myxoid Chondrosarcoma with Molecularly Confirmed Diagnosis: A Multicenter Retrospective Study Within the Italian Sarcoma Group. Ann Surg Oncol 2020; 28:1142-1150. [PMID: 32572850 DOI: 10.1245/s10434-020-08737-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma of uncertain origin, marked by specific chromosomal translocations involving the NR4A3 gene, and usually characterized by an indolent course. Surgery (with or without radiotherapy) is the treatment of choice in localized disease. The treatment for advanced disease remains uncertain. In order to better evaluate prognostic factors and outcome, a retrospective pooled analysis of patients with EMC treated at three Italian Sarcoma Group (ISG) referral centers was carried out. METHODS All patients with localized EMC surgically treated from 1989 to 2016 were identified. Diagnosis was centrally reviewed according to WHO 2013. Only patients with NR4A3 rearrangement were included. RESULTS Sixty-seven patients were identified: 13 (20%) female, 54 (80%) male. Median age was 56 years (range 18-84). Numbers and type of translocation were: 50 (80%) NR4A3-EWS, 10 (16%) NR4A3-TAF15, 1 (2%) NR4A3-TCF12, and 1 (2%) NR4A3-TFG. Median follow-up was 55 months (range 2-312). Five- and ten-year overall survival rates were 94% (86-100 95%CI) and 84% (69-98 95%CI). Thirty-five (52%) patients relapsed: 9 had local recurrence (LR) and 26 had distant metastasis (5 with concomitant LR). The 5- and 10-year disease-free survival rates (DFS) were 51% (38-65 95%CI) and 20% (7-33 95%CI). Size of the primary tumor was significantly related to distant metastasis-free survival (DMFS) (p = 0.004). Patients carrying the NR4A3-EWS translocation had a trend in favor of better DFS (p = 0.08) and DMFS (p = 0.09) compared with the patients with NR4A3-TAF15. CONCLUSIONS Prolonged survival can be expected in patients with EMC, in spite of a high rate of recurrence. Size is significantly associated with distant relapse. The type of NR4A3 translocation could influence outcome.
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Affiliation(s)
- Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Silvia Stacchiotti
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Domenico Campanacci
- Department of Orthopedic Oncology, Azienda Ospedaliera Careggi, Florence, Italy
| | | | - Anna Maria Frezza
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Beltrami
- Department of Orthopedic Oncology, Azienda Ospedaliera Careggi, Florence, Italy
| | - Giuseppe Bianchi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefania Benini
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Piero Picci
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Italian Sarcoma Group (I.S.G.), San Lazzaro di Savena, Bologna, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Chiusole B, Le Cesne A, Rastrelli M, Maruzzo M, Lorenzi M, Cappellesso R, Del Fiore P, Imbevaro S, Sbaraglia M, Terrier P, Ruggieri P, Dei Tos AP, Rossi CR, Zagonel V, Brunello A. Extraskeletal Myxoid Chondrosarcoma: Clinical and Molecular Characteristics and Outcomes of Patients Treated at Two Institutions. Front Oncol 2020; 10:828. [PMID: 32612944 PMCID: PMC7308468 DOI: 10.3389/fonc.2020.00828] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Extraskeletal myxoid chondrosarcoma (EMC) is a rare subtype of STS, which usually arises in extremities. It carries reciprocal translocations involving the NR4A3 gene. It displays an indolent behavior, but studies with long follow-up showed a high proportion of local and distant recurrences. For patients with progressing metastatic disease anthracycline-based chemotherapy is the standard front-line regimen, though has limited activity. There is some evidence on possible activity of antiangiogenetics. Methods: This is a retrospective study conducted at Istituto Oncologico Veneto and at Institut Gustave Roussy. All patients with a confirmed diagnosis of EMC from January 1980 to December 2018 were extracted from a prospectively maintained database. Results: 59 patients were identified, 37 male (62.7%) and 22 female (37.3%) with a M/F ratio of 1.7/1. We performed molecular analysis in 23 cases, all carried a EWSR1-NR4A3. Out of 49 patients treated with curative intent, 28.6% developed local recurrence and 40.8% patients developed metastases. In patients who had been radically resected (R0) local recurrence occurred in 7.6% of cases and metastases occurred in 15.4% of cases; in patients treated with R1 surgery, rates of relapse were higher. Twenty patients received chemotherapy for metastatic disease; best response was partial response with clinical benefit in 50% of patients. Fourteen patients received a second line of chemotherapy, with 46.1% disease control rate. A drug holiday was proposed to 8 patients with a mean duration of 22.8 months. Median overall survival was 180 months for the study population and 76 months for metastatic patients. No significant prognostic role was found for all studied variables, yet a trend of better survival for complete surgery, location in extremities of primary tumor and solitary lung metastases was observed. Chemotherapy for metastatic disease was negatively associated with survival. Conclusion: In this large retrospective cohort of patients with ECM, location of primary tumor and solitary lung metastases seem to be associated with better survival. Chemotherapy did not impact survival in unselected patients. Further research is necessary in order to identify more active regimens and to provide clinical and molecular factors to select patients that could delay systemic treatment for metastatic disease.
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Affiliation(s)
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - Marco Rastrelli
- Surgical Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marco Maruzzo
- Medical Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Martina Lorenzi
- Medical Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Paolo Del Fiore
- Surgical Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Silvia Imbevaro
- Accreditation and Aknowledgment Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Philippe Terrier
- Department of Biology and Medical Pathology, Institut Gustave Roussy, Villejuif, France
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | | | - Carlo Riccardo Rossi
- Surgical Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
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14
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Stacchiotti S, Ferrari S, Redondo A, Hindi N, Palmerini E, Vaz Salgado MA, Frezza AM, Casali PG, Gutierrez A, Lopez-Pousa A, Grignani G, Italiano A, LeCesne A, Dumont S, Blay JY, Penel N, Bernabeu D, de Alava E, Karanian M, Morosi C, Brich S, Dagrada GP, Vallacchi V, Castelli C, Brenca M, Racanelli D, Maestro R, Collini P, Cruz J, Martin-Broto J. Pazopanib for treatment of advanced extraskeletal myxoid chondrosarcoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol 2019; 20:1252-1262. [DOI: 10.1016/s1470-2045(19)30319-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022]
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15
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Araki N. Fusion gene-oriented precision medicine in soft tissue sarcoma. Lancet Oncol 2019; 20:1189-1190. [PMID: 31331698 DOI: 10.1016/s1470-2045(19)30403-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal hospital, Hyogo 659-8502, Japan.
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16
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Brenca M, Stacchiotti S, Fassetta K, Sbaraglia M, Janjusevic M, Racanelli D, Polano M, Rossi S, Brich S, Dagrada GP, Collini P, Colombo C, Gronchi A, Astolfi A, Indio V, Pantaleo MA, Picci P, Casali PG, Dei Tos AP, Pilotti S, Maestro R. NR4A3 fusion proteins trigger an axon guidance switch that marks the difference between EWSR1 and TAF15 translocated extraskeletal myxoid chondrosarcomas. J Pathol 2019; 249:90-101. [PMID: 31020999 PMCID: PMC6766969 DOI: 10.1002/path.5284] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/09/2019] [Accepted: 04/19/2019] [Indexed: 12/31/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare sarcoma histotype with uncertain differentiation. EMC is hallmarked by the rearrangement of the NR4A3 gene, which in most cases fuses with EWSR1 or TAF15. TAF15‐translocated EMC seem to feature a more aggressive course compared to EWSR1‐positive EMCs, but whether the type of NR4A3 chimera impinges upon EMC biology is still largely undefined. To gain insights on this issue, a series of EMC samples (7 EWSR1‐NR4A3 and 5 TAF15‐NR4A3) were transcriptionally profiled. Our study unveiled that the two EMC variants display a distinct transcriptional profile and that the axon guidance pathway is a major discriminant. In particular, class 4–6 semaphorins and axonal guidance cues endowed with pro‐tumorigenic activity were more expressed in TAF15‐NR4A3 tumors; vice versa, class 3 semaphorins, considered to convey growth inhibitory signals, were more abundant in EWSR1‐NR4A3 EMC. Intriguingly, the dichotomy in axon guidance signaling observed in the two tumor variants was recapitulated in in vitro cell models engineered to ectopically express EWSR1‐NR4A3 or TAF15‐NR4A3. Moreover, TAF15‐NR4A3 cells displayed a more pronounced tumorigenic potential, as assessed by anchorage‐independent growth. Overall, our results indicate that the type of NR4A3 chimera dictates an axon guidance switch and impacts on tumor cell biology. These findings may provide a framework for interpretation of the different clinical–pathological features of the two EMC variants and lay down the bases for the development of novel patient stratification criteria and therapeutic approaches. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Monica Brenca
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Silvia Stacchiotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Kelly Fassetta
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Marta Sbaraglia
- Department of Pathology, Treviso Regional Hospital, Treviso, Italy
| | - Milijana Janjusevic
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Dominga Racanelli
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Maurizio Polano
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
| | - Sabrina Rossi
- Department of Pathology, Treviso Regional Hospital, Treviso, Italy
| | - Silvia Brich
- Unit of Experimental Molecular Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gian P Dagrada
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Maria A Pantaleo
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Piero Picci
- Laboratory of Experimental Oncology, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo G Casali
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Milano, Italy
| | - Angelo P Dei Tos
- Department of Pathology, Treviso Regional Hospital, Treviso, Italy.,Department of Medicine, University of Padua School of Medicine, Padova, Italy
| | - Silvana Pilotti
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Roberta Maestro
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, National Cancer Institute, Aviano, Italy
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17
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Paoluzzi L, Ghesani M. Extraskeletal myxoid chondrosarcoma with massive pulmonary metastases. Clin Sarcoma Res 2018. [PMID: 30534357 DOI: 10.1186/s13569-018-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant mesenchymal neoplasm of uncertain differentiation characterized by rearrangements of the NR4A3 gene. EMC often affects adults around the age of 50 and arise in the deep tissues of the proximal extremities and limb girdles. EMC is characterized by indolent growth rate but strong tendency to local recurrence and metastatic spread. No systemic treatment is specifically approved by the FDA for this disease and surgery has been traditionally the only potentially curative strategy. Case presentation A 41-year-old Caucasian woman originally presented with a 14.8 cm left thigh mass. She was managed with wide local resection but after 2 years she developed recurrent disease in the pelvis and in the lungs; the lung involvement was characterized by innumerable nodules without any significant respiratory symptoms. After failing three clinical trials, she experienced prolonged disease control while on treatment with the tyrosine kinase inhibitor (TKI) pazopanib and radiation therapy delivered to the pelvic lesion. Dose reduction of pazopanib due to severe diarrhea was followed by rapid disease progression in the pelvis requiring vascular stenting; increase in tumor growth after discontinuation of a TKI has been described in other malignancies and is a possibility in this specific patient. Conclusion While surgical management of EMC with or without radiation therapy is still the preferable approach when feasible, small series support the use of tyrosine kinase inhibitors and possible new immunotherapies in selected patients. Basket trials focusing on diseases with unique genomic features such as EMC will hopefully provide a better understanding of new options for care.
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Affiliation(s)
- Luca Paoluzzi
- 1Department of Medicine, Sarcoma Medical Oncology, NYU Langone Medical Center, 160 East 34th Street, New York, NY 10016 USA
| | - Munir Ghesani
- 2Department of Radiology, NYU Langone Medical Center, New York, NY USA
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18
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Paoluzzi L, Ghesani M. Extraskeletal myxoid chondrosarcoma with massive pulmonary metastases. Clin Sarcoma Res 2018; 8:20. [PMID: 30534357 PMCID: PMC6280406 DOI: 10.1186/s13569-018-0108-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant mesenchymal neoplasm of uncertain differentiation characterized by rearrangements of the NR4A3 gene. EMC often affects adults around the age of 50 and arise in the deep tissues of the proximal extremities and limb girdles. EMC is characterized by indolent growth rate but strong tendency to local recurrence and metastatic spread. No systemic treatment is specifically approved by the FDA for this disease and surgery has been traditionally the only potentially curative strategy. Case presentation A 41-year-old Caucasian woman originally presented with a 14.8 cm left thigh mass. She was managed with wide local resection but after 2 years she developed recurrent disease in the pelvis and in the lungs; the lung involvement was characterized by innumerable nodules without any significant respiratory symptoms. After failing three clinical trials, she experienced prolonged disease control while on treatment with the tyrosine kinase inhibitor (TKI) pazopanib and radiation therapy delivered to the pelvic lesion. Dose reduction of pazopanib due to severe diarrhea was followed by rapid disease progression in the pelvis requiring vascular stenting; increase in tumor growth after discontinuation of a TKI has been described in other malignancies and is a possibility in this specific patient. Conclusion While surgical management of EMC with or without radiation therapy is still the preferable approach when feasible, small series support the use of tyrosine kinase inhibitors and possible new immunotherapies in selected patients. Basket trials focusing on diseases with unique genomic features such as EMC will hopefully provide a better understanding of new options for care.
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Affiliation(s)
- Luca Paoluzzi
- 1Department of Medicine, Sarcoma Medical Oncology, NYU Langone Medical Center, 160 East 34th Street, New York, NY 10016 USA
| | - Munir Ghesani
- 2Department of Radiology, NYU Langone Medical Center, New York, NY USA
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19
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Batsis ID, Offenbacher R, Rybinski B, Pawel B, Weiser DA. Systemic manifestations of extraskeletal myxoid chondrosarcoma associated with a novel t(2;22)(q34;q12) EWS translocation in a child and a review of the literature. Pediatr Hematol Oncol 2018; 35:434-441. [PMID: 30776935 DOI: 10.1080/08880018.2018.1557766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Extraskeletal myxoid chondrosarcoma (EMC), a soft-tissue sarcoma with unique clinicopathologic features and characteristic chromosomal translocations, is extremely rare in the pediatric population. We, herein, present the case of a 7-year-old boy with profound microcytic hypochromic anemia, poor weight gain and a mid-thoracic paraspinal mass that was identified as EMC. Systemic manifestations of localized, nonmetastatic EMC have never been described in the pediatric population, yet our patient's anemia and poor weight gain resolved after successful surgical resection of the tumor, suggesting that localized EMC can present with systemic manifestations. The tumor also contained a novel t(2;22)(q34;q12) translocation involving the EWSR1 gene, which is consistent with additional reports suggesting that a growing list of translocations can drive formation of, and potential new management strategies for, EMC.
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Affiliation(s)
- Irini D Batsis
- a Johns Hopkins Children's Center , Baltimore , Maryland , USA
| | | | - Brad Rybinski
- c Albert Einstein College of Medicine , Bronx , New York , USA
| | - Bruce Pawel
- d Children's Hospital at Philadelphia , Pennsylvania , USA
| | - Daniel A Weiser
- b The Children's Hospital at Montefiore , Bronx , New York , USA.,c Albert Einstein College of Medicine , Bronx , New York , USA
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20
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Urbini M, Indio V, Astolfi A, Tarantino G, Renne SL, Pilotti S, Dei Tos AP, Maestro R, Collini P, Nannini M, Saponara M, Murrone L, Dagrada GP, Colombo C, Gronchi A, Pession A, Casali PG, Stacchiotti S, Pantaleo MA. Identification of an Actionable Mutation of KIT in a Case of Extraskeletal Myxoid Chondrosarcoma. Int J Mol Sci 2018; 19:ijms19071855. [PMID: 29937513 PMCID: PMC6073125 DOI: 10.3390/ijms19071855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 01/03/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is an extremely rare soft tissue sarcoma, marked by a translocation involving the NR4A3 gene. EMC is usually indolent and moderately sensitive to anthracycline-based chemotherapy. Recently, we reported on the therapeutic activity of sunitinib in a series of EMC cases, however the molecular target of sunitinib in EMC is unknown. Moreover, there is still the need to identify alternative therapeutic strategies. To better characterize this disease, we performed whole transcriptome sequencing in five EMC cases. Peculiarly, in one sample, an in-frame deletion (c.1735_1737delGAT p.D579del) was identified in exon 11 of KIT. The deletion was somatic and heterozygous and was validated both at DNA and mRNA level. This sample showed a marked high expression of KIT at the mRNA level and a mild phosphorylation of the receptor. Sanger sequencing of KIT in additional 15 Formalin Fixed Paraffin Embedded (FFPE) EMC did not show any other mutated cases. In conclusion, exon 11 KIT mutation was detected only in one out of 20 EMC cases analyzed, indicating that KIT alteration is not a recurrent event in these tumors and cannot explain the EMC sensitivity to sunitinib, although it is an actionable mutation in the individual case in which it has been identified.
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MESH Headings
- Base Sequence
- Chondrosarcoma/diagnosis
- Chondrosarcoma/genetics
- Chondrosarcoma/metabolism
- Chondrosarcoma/pathology
- Computational Biology
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Exons
- Gene Expression Regulation, Neoplastic
- Humans
- Neoplasms, Connective and Soft Tissue/diagnosis
- Neoplasms, Connective and Soft Tissue/genetics
- Neoplasms, Connective and Soft Tissue/metabolism
- Neoplasms, Connective and Soft Tissue/pathology
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Proto-Oncogene Proteins c-kit/genetics
- Proto-Oncogene Proteins c-kit/metabolism
- RNA-Binding Protein EWS/genetics
- RNA-Binding Protein EWS/metabolism
- Receptors, Steroid/genetics
- Receptors, Steroid/metabolism
- Receptors, Thyroid Hormone/genetics
- Receptors, Thyroid Hormone/metabolism
- Sequence Deletion
- Transcriptome
- Exome Sequencing
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Affiliation(s)
- Milena Urbini
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Giuseppe Tarantino
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Salvatore Lorenzo Renne
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Silvana Pilotti
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | | | - Roberta Maestro
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, 33081 Aviano, Italy.
| | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Ludovica Murrone
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Gian Paolo Dagrada
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Andrea Pession
- "Giorgio Prodi" Cancer Research Center, University of Bologna, 40138 Bologna, Italy.
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133Milan, Italy.
| | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
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21
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Purkayastha A, Sharma N, Dutta V. Extraskeletal Myxoid Chondrosarcoma of Nasopharynx: An Oncologic Entity Rarely Reported. Oman Med J 2018; 33:159-162. [PMID: 29657686 DOI: 10.5001/omj.2018.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (ESMC) is an extremely rare variant of chondrosarcoma accounting for less than 10% cases. It affects mainly the soft tissues of the proximal end of long bones. Its incidence in the head and neck region is less than 5%. This case presented in the nasopharynx, an exceedingly unusual site for ESMC in a 60-year-old female with left-sided nasal obstruction and occasional epistaxis of one-year duration. Biopsy from the nasopharyngeal mass was suggestive of low-grade chondrosarcoma. She underwent endoscopic resection of the tumor. Postoperative histopathology confirmed the diagnosis as myxoid chondrosarcoma of nasopharynx after performing a battery of immunohistochemical markers to rule out other possible differential diagnoses. We treated her with conformal adjuvant radiotherapy to a dose of 66 Gray in 33 fractions given residual disease to which she responded well with significant symptomatic and radiological improvement. The patient has been on regular follow-up for over two years without any evidence of recurrence or distant metastasis. This case is presented to highlight the extreme rarity, the clinicopathological findings of this disease, and to emphasize the role of radiotherapy as the primary adjuvant treatment affecting the final prognosis. A thorough review of the literature reveals that our case may be the second case of myxoid chondrosarcoma of nasopharynx ever reported in the world literature to date.
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Affiliation(s)
- Abhishek Purkayastha
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, India
| | - Neelam Sharma
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, India
| | - Vibha Dutta
- Department of Pathology and Molecular Science, Army Hospital Research and Referral, New Delhi, India
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22
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Bupathi M, Hays JL, Chen JL. Temozolomide post pazopanib treatment failure in patients with advanced sarcoma: A case series. PLoS One 2017; 12:e0188116. [PMID: 29141017 PMCID: PMC5687737 DOI: 10.1371/journal.pone.0188116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/01/2017] [Indexed: 11/19/2022] Open
Abstract
Background Sarcomas are rare, heterogeneous tumors for which prognosis remains dismal in patients with advanced disease. Pazopanib, a vascular endothelial growth factor receptor inhibitor, has shown modest efficacy in patients with soft tissue sarcoma who fail cytotoxic chemotherapy. The cytotoxic agent temozolomide has also demonstrated activity in patients with advanced sarcoma. Objective We performed a retrospective case series to evaluate the feasibility of adding temozolomide to pazopanib in advanced sarcoma patients following single-agent pazopanib failure. Patients and methods Patients with recurrent, metastatic sarcomas who had progressed on single-agent pazopanib and continued on pazopanib with the addition of temozolomide were included in this retrospective analysis to examine the tolerability and responses associated with the treatment combination. Results Nine patients with a range of sarcoma subtypes were identified (55% female; median age, 48 years; median number of therapies prior to pazopanib, 3). All patients received combination therapy. One patient was recently started on therapy and was excluded from the analysis (n = 8 evaluable patients). Median PFS for single-agent pazopanib was 7.5 months (range 2–19). For the eight evaluable patients (63% female), best response at 4 months with pazopanib plus temozolomide was partial response (n = 1), stable disease (n = 3) and progressive disease (n = 4), with a median PFS of 3.5 months (range 0–15). Median PFS with combination treatment in patients with stable disease or response was 8 months (range 5–15). All four patients who achieved clinical benefit remain on therapy and are tolerating the combination therapy with expected but manageable side effects. Conclusions In heavily pretreated patients with advanced sarcoma, the addition of temozolomide to pazopanib was found to be tolerable. Future prospective trials are required to deduce whether temozolomide extends the clinical benefit of pazopanib.
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Affiliation(s)
- Manojkumar Bupathi
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University, Columbus, Ohio, United States of America
| | - John L. Hays
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ohio State University, Columbus, Ohio, United States of America
- Department of Biomedical Informatics, Division of Bioinformatics, Ohio State University, Columbus, Ohio, United States of America
| | - James L. Chen
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University, Columbus, Ohio, United States of America
- Department of Biomedical Informatics, Division of Bioinformatics, Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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23
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Davis EJ, Wu YM, Robinson D, Schuetze SM, Baker LH, Athanikar J, Cao X, Kunju LP, Chinnaiyan AM, Chugh R. Next generation sequencing of extraskeletal myxoid chondrosarcoma. Oncotarget 2017; 8:21770-21777. [PMID: 28423517 PMCID: PMC5400622 DOI: 10.18632/oncotarget.15568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/09/2017] [Indexed: 12/29/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is an indolent translocation-associated soft tissue sarcoma with a high propensity for metastases. Using a clinical sequencing approach, we genomically profiled patients with metastatic EMC to elucidate the molecular biology and identify potentially actionable mutations. We also evaluated potential predictive factors of benefit to sunitinib, a multi-targeted tyrosine kinase inhibitor with reported activity in a subset of EMC patients. Between January 31, 2012 and April 15, 2016, six patients with EMC participated in the clinical sequencing research study. High quality DNA and RNA was isolated and matched normal samples underwent comprehensive next generation sequencing (whole or OncoSeq capture exome of tumor and normal, tumor PolyA+ and capture transcriptome). The expression levels of sunitinib targeted-kinases were measured by transcriptome sequencing for KDR, PDGFRA/B, KIT, RET, FLT1, and FLT4. The previously reported EWSR1-NR4A3 translocation was identified in all patient tumors; however, other recurring genomic abnormalities were not detected. RET expression was significantly greater in patients with EMC relative to other types of sarcomas except for liposarcoma (p<0.0002). The folate receptor was overexpressed in two patients. Our study demonstrated that similar to other translocation-associated sarcomas, the mutational profile of metastatic EMC is limited beyond the pathognomonic translocation. The clinical significance of RET expression in EMC should be explored. Additional pre-clinical investigations of EMC may help elucidate molecular mechanisms contributing to EMC tumorigenesis that could be translated to the clinical setting.
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Affiliation(s)
- Elizabeth J Davis
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Dan Robinson
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Scott M Schuetze
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Laurence H Baker
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jyoti Athanikar
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Xuhong Cao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lakshmi P Kunju
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rashmi Chugh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Feuer ZS, Fine ND, Chouhan JD, Segal DA, Tyler M, Xie S, Hammill PJ, Hyacinthe LM, McNeil BK, Winer AG. A 75-Year-Old African American Woman With an Incidentally Identified Renal Mass After Traumatic Fall. Urology 2017; 111:28-31. [PMID: 28893631 DOI: 10.1016/j.urology.2017.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Jyoti D Chouhan
- SUNY Downstate Medical Center, Department of Urology, Brooklyn, NY; Kings County Hospital Center, Division of Urology, Brooklyn, NY.
| | | | - Michael Tyler
- SUNY Downstate Medical Center, Department of Urology, Brooklyn, NY; Kings County Hospital Center, Division of Urology, Brooklyn, NY
| | - Steve Xie
- Kings County Hospital Center, Department of Pathology, Brooklyn, NY
| | | | | | - Brian K McNeil
- SUNY Downstate Medical Center, Department of Urology, Brooklyn, NY; Kings County Hospital Center, Division of Urology, Brooklyn, NY
| | - Andrew G Winer
- SUNY Downstate Medical Center, Department of Urology, Brooklyn, NY; Kings County Hospital Center, Division of Urology, Brooklyn, NY
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25
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Urbini M, Astolfi A, Pantaleo MA, Serravalle S, Dei Tos AP, Picci P, Indio V, Sbaraglia M, Benini S, Righi A, Gambarotti M, Gronchi A, Colombo C, Dagrada GP, Pilotti S, Maestro R, Polano M, Saponara M, Tarantino G, Pession A, Biasco G, Casali PG, Stacchiotti S. HSPA8 as a novel fusion partner of NR4A3 in extraskeletal myxoid chondrosarcoma. Genes Chromosomes Cancer 2017; 56:582-586. [PMID: 28383167 DOI: 10.1002/gcc.22462] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 01/30/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a very rare sarcoma most often arising in the soft tissue. Rare EMC of the bone have been reported. EMC exhibits distinctive clinico-pathological and genetic features; however, despite the name, it lacks any feature of cartilaginous differentiation. EMC is characterized by the rearrangement of the NR4A3, which, in most cases (about 62-75%), is fused with EWSR1 and less frequently with other partners, including TAF15 (27%), TCF12 (4%), TFG, and FUS. We herein report the identification by whole-transcriptome sequencing of HSPA8 as a novel fusion partner of NR4A3 in a case of EMC. FISH analysis confirmed the presence of a genomic HSPA8-NR4A3 translocation in the vast majority of tumor cells. Our findings expand the spectrum of NR4A3 fusion partners involved in EMC pathobiology.
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Affiliation(s)
- Milena Urbini
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Maria Abbondanza Pantaleo
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Serravalle
- Department of Pediatrics, "Lalla Seràgnoli", Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Piero Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Valentina Indio
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Marta Sbaraglia
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Stefania Benini
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Gronchi
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Colombo
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gian Paolo Dagrada
- Laboratory of Experimental Molecular Pathology, Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvana Pilotti
- Laboratory of Experimental Molecular Pathology, Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberta Maestro
- Oncogenetics and Functional Oncogenomics (FOGG), CRO Aviano National Cancer Institute, Aviano, Italy
| | - Maurizio Polano
- Oncogenetics and Functional Oncogenomics (FOGG), CRO Aviano National Cancer Institute, Aviano, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Tarantino
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Andrea Pession
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
- Department of Pediatrics, "Lalla Seràgnoli", Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Guido Biasco
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Giovanni Casali
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori Milan, Italy
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26
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Extraskeletal myxoid chondrosarcoma of the neck. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Balanzá R, Arrangoiz R, Cordera F, Muñoz M, Luque-de-León E, Moreno E, Molinar L, Somerville N. Pulmonary extraskeletal myxoid chondrosarcoma: A case report and literature review. Int J Surg Case Rep 2016; 27:96-101. [PMID: 27591381 PMCID: PMC5011171 DOI: 10.1016/j.ijscr.2016.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/11/2016] [Indexed: 01/29/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) is a rare tumor characterized by the multinodular growth of primitive chondroid cells in an abundant myxoid matrix. EMC is categorized as a tumor of uncertain differentiation by the 2002 WHO classification. EMC has shown to have the recurrent balanced chromosomal translocation t(9;22) (q22;q12.2), which leads to the oncogenic fusion gene EWSR1-NR4A3. EMC usually presents in male patients beyond their fifth decade as a slow growing, palpable mass in the extremities. Pulmonary extraskeletal myxoid chondrosarcomas are extremely rare with only isolated case reports found in the literature.
Background Extraskeletal myxoid chondrosarcoma (EMC) accounts for the 3% of all soft tissue sarcomas and it's categorized as a tumour of uncertain differentiation. This entity has shown to have the recurrent balanced chromosomal translocation t(9;22) (q22;q12.2), which leads to the oncogenic fusion gene EWSR1-NR4A3. This sarcoma usually presents as a slow growing, palpable mass in the extremities. EMC arising from the lung is extremely infrequent. We report one case of pulmonary extraskeletal mixoid chondrosarcoma and a review of the world literature. Case report A 69-year-old male patient presented with intermittent hemoptysis for the last 6 months. A PET/CT scan showed a hypermetabolic solid mass with lobulated borders of approximately 29 × 26 mm in the inferior right lobe. We performed a right thoracotomy with inferior lobectomy and lymphadenectomy of levels VII, VIII, X, and XI levels. The neoplasm was constituted by cords of small cells with small round nucleus and scarce cytoplasm immerse in an abundant myxoid matrix. The immunophenotype was positive for MUM-1, CDK4, MDM2, and showed focal expression for S-100 protein and CD56. The final pathology report revealed a pulmonary extraskeletal mixoid chondrosarcoma. No further surgical interventions or adjuvant therapies were needed. Conclusion EMC is an intermediate-grade neoplasm, characterized by a long clinical course with high potential for local recurrence and distant metastasis. Treatment for EMC is surgical and non-surgical treatment is reserved for recurrence or metastatic disease. Pulmonary extraskeletal myxoid chondrosarcoma is a rare neoplasm with only isolated case reports found in the literature.
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Affiliation(s)
- Ricardo Balanzá
- General Surgery Resident, Hospital Ángeles Lomas, Av. Vialidad de la Barranca s/n, Col. Valle de las Palmas Huixquilucan, Estado de México, C.P. 52763, Mexico
| | - Rodrigo Arrangoiz
- Department of Surgery, Hospital Ángeles Lomas, Av. Vialidad de la Barranca s/n, Col. Valle de las Palmas Huixquilucan, Estado de México, C.P. 52763, Mexico; Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal, C.P. 05300, Mexico.
| | - Fernando Cordera
- Department of Surgery, Hospital Ángeles Lomas, Av. Vialidad de la Barranca s/n, Col. Valle de las Palmas Huixquilucan, Estado de México, C.P. 52763, Mexico; Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal, C.P. 05300, Mexico
| | - Manuel Muñoz
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal, C.P. 05300, Mexico
| | - Enrique Luque-de-León
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal, C.P. 05300, Mexico
| | - Eduardo Moreno
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal, C.P. 05300, Mexico
| | - Lourdes Molinar
- Department of Pathology, Hospital Ángeles Lomas, Av. Vialidad de la Barranca s/n, Col. Valle de las Palmas Huixquilucan, Estado de México, C.P. 52763, Mexico
| | - Nicole Somerville
- Universidad Anáhuac Norte, Av. Universidad Anáhuac 46, Col. Lomas Anáhuac, Huixquilucan, Estado de México, C.P. 52786, Mexico
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28
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Shao R, Lao IW, Wang L, Yu L, Wang J, Fan Q. Clinicopathologic and radiologic features of extraskeletal myxoid chondrosarcoma: a retrospective study of 40 Chinese cases with literature review. Ann Diagn Pathol 2016; 23:14-20. [PMID: 27402218 DOI: 10.1016/j.anndiagpath.2016.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/21/2016] [Accepted: 04/04/2016] [Indexed: 01/20/2023]
Abstract
The aim of this study is to describe the clinicopathologic and radiologic features of 40 cases of extraskeletal myxoid chondrosarcoma (EMC) from China. There were 25 males and 15 females (sex ratio, 1.7:1). Apart from an adolescent, all patients were adults with a median age of 49years. Twenty-four tumors (60%) occurred in the lower limb and limb girdles, especially the thigh, followed by the upper limb and limb girdles (20%) and trunk (10%). Other less commonly involved locations included the head and neck, sacrococcygeal region, and perineum. Tumors ranged in size from 1.5 to 19cm (mean, 7cm). By radiology, they appeared as hypoattenuated or isoattenuated masses on computed tomography with hyperintense signal on T2-weighted magnetic resonance imaging. Intralesional hypointense septa were present in most cases. Of the 40 tumors, 30 belonged to the classic subtype, whereas 9 cases were cellular, and 1 case had a rhabdoid phenotype. Tumor cells showed variable expression of synaptophysin (36%), S-100 protein (29%), epithelial membrane antigen (11%), and neuron-specific enolase (7%). Ki-67 index was remarkably higher in the cellular variant (mean, 30%). EWSR1-related rearrangement was detected in 12 of 14 cases tested by fluorescence in situ hybridization using break-apart probes. The overall 5- and 7-year survival was 71% and 60%, respectively. Awareness of the imaging features may help pathologists in the diagnosis of EMC. Fluorescence in situ hybridization also serves as a useful diagnostic tool for EMC, especially in the distinction from its mimics.
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Affiliation(s)
- Rui Shao
- Department of Pathology, Zhenjiang First People's Hospital, Jiangsu University, Zhenjiang 212001, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lei Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
| | - Qinhe Fan
- Department of Pathology, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210000, China
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29
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Zaki M, Laszewski P, Robinette N, Saleh H, Raza N, Sukari A, Kim H. Unresectable Extraskeletal Myxoid Chondrosarcoma of the Neck: Early Tumor Response to Chemoradiotherapy. Cureus 2015; 7:e432. [PMID: 26848421 PMCID: PMC4727951 DOI: 10.7759/cureus.432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) rarely occurs in the head and neck and is generally managed with primary surgery. To our knowledge, no cases of unresectable EMC of the neck have been reported. We present a case of an unresectable EMC treated with chemotherapy and radiation, and highlight the exceptional early response to therapy.
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Affiliation(s)
- Mark Zaki
- Radiation Oncology, Karmanos Cancer Center
| | | | | | | | | | | | - Harold Kim
- Radiation Oncology, Karmanos Cancer Center
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30
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Ortiz AM, Fernández N, Villareal N, Vargas R, Varela R. Condrosarcoma mesenquimal peneano: primer reporte de caso. UROLOGÍA COLOMBIANA 2015. [DOI: 10.1016/j.uroco.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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31
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Abstract
Soft tissue tumors (STTs) are rare mesenchymal neoplasms accounting for less than 1% of adult cancers. More than 50 different subtypes of STTs have been identified, with this number expected to grow as our understanding of the complex genetic landscape of these diseases improves. As the classification of soft tissue neoplasms continues to diversify, so does the approach to therapy. Accurate histopathologic diagnosis, utilizing the appropriate ancillary immunohistochemical and molecular diagnostic platforms, underpins the oncologic management of soft tissue sarcomas. As increasing numbers of reproducible genetic abnormalities in soft tissue neoplasms are defined, molecular genetic and molecular cytogenetic investigations have become a standard part of the ancillary diagnostic repertoire. However, other soft tissue neoplasms lack reproducible genetic abnormalities, and for these, traditional histology and immunohistochemistry remain the cornerstones for diagnosis. Here, we give an overview of histology-driven therapy in STTs, highlighting the critical role of accurate surgical pathology in guiding the systemic treatment of patients with these neoplasms, and the importance of close collaboration between the surgical pathologist and the oncologist. We also summarize what is considered standard practice in nonhistology- and histology-driven therapy.
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32
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Stacchiotti S, Pantaleo MA, Astolfi A, Dagrada GP, Negri T, Dei Tos AP, Indio V, Morosi C, Gronchi A, Colombo C, Conca E, Toffolatti L, Tazzari M, Crippa F, Maestro R, Pilotti S, Casali PG. Activity of sunitinib in extraskeletal myxoid chondrosarcoma. Eur J Cancer 2014; 50:1657-64. [PMID: 24703573 DOI: 10.1016/j.ejca.2014.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma, marked by NR4A3 rearrangement. Herein we report on the activity of sunitinib in a series of 10 patients, strengthening what initially observed in two cases. PATIENTS AND METHODS From July 2011, 10 patients with progressive metastatic translocated EMC have been consecutively treated with sunitinib 37.5mg/day, on a named-use basis. In an attempt to interpret the activity of sunitinib in EMC, genotype/phenotype correlations were carried out by fluorescence in situ hybridization (FISH) analyses. Moreover, transcriptome, immunohistochemical and biochemical analyses of a limited set of samples were performed focusing on some putative targets of sunitinib. RESULTS Eight of 10 patients are still on therapy. Six patients had a Response Evaluation Criteria in Solid Tumours (RECIST) partial response (PR), two were stable, two progressed. Positron emission tomography (PET) was consistent in 6/6 evaluable cases. One patient underwent surgery after sunitinib, with evidence of a pathologic response. At a median follow-up of 8.5 months (range 2-28), no secondary resistance was detected. Median progression free survival (PFS) has not been reached. Interestingly, all responsive cases turned out to express the typical EWSR1-NR4A3 fusion, while refractory cases carried the alternative TAF15-NR4A3 fusion. Among putative sunitinib targets, only RET was expressed and activated in analysed samples. CONCLUSIONS This report confirms the therapeutic activity of sunitinib in EMC. Genotype/phenotype analyses support a correlation between response and EWSR1-NR4A3 fusion. Involvement of RET deserves further investigation.
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Affiliation(s)
- S Stacchiotti
- Adult Mesenchymal Tumor Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - M A Pantaleo
- Dipartimento di Medicina Sperimentale, Specialistica e Diagnostica, Università di Bologna, Bologna, Italy
| | - A Astolfi
- Centro Interdipartimentale di Ricerche sul Cancro "G. Prodi", Università di Bologna, Bologna, Italy
| | - G P Dagrada
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - T Negri
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A P Dei Tos
- Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy
| | - V Indio
- Centro Interdipartimentale di Ricerche sul Cancro "G. Prodi", Università di Bologna, Bologna, Italy
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - E Conca
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - L Toffolatti
- Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy
| | - M Tazzari
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - F Crippa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R Maestro
- Unit of Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - S Pilotti
- Experimental Molecular Pathology Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - P G Casali
- Adult Mesenchymal Tumor Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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