1
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Cagan M, Yildirim S, Turkmen GG, Ozyuncu O, Akcoren Z, Deren O, Gucer S. Fetal Mediastinal Fibrosarcoma. Report of Two Cases. Fetal Pediatr Pathol 2022; 41:843-851. [PMID: 34622726 DOI: 10.1080/15513815.2021.1988010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: One-third of fetal soft tissue tumors are malignant and include congenital fibrosarcoma (CF). We report two fetal CFs arising in the posterior mediastinum. Case Presentation: In case 1, the CF resulted in a mediastinal shift, extensive infiltration of the tumor around adjacent structures, pulmonary hypoplasia, pleural effusion, and rapid growth. The pregnancy was terminated. Case 2 had multiple intrathoracic masses, thoracic hypoplasia, pleural effusion, and fetal death. Both were diagnosed as fibrosarcoma at fetopsy. Discussion: Although congenital CF tends to be locally aggressive with a low metastatic rate, it tends to grow rapidly and the tumor location can affect fetal survival. In Case 1, the tumor demonstrated locally aggressive behavior whereas multiple distant metastases such as lung, liver, adrenals, and left eye were detected in Case 2. The tumor was directly responsible for intrauterine fetal demise in the second case.
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Affiliation(s)
- Murat Cagan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Selma Yildirim
- Department of Pathology, Hacettepe University, Ankara, Turkey
| | | | - Ozgur Ozyuncu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Zuhal Akcoren
- Division Pediatric Pathology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Ozgur Deren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Safak Gucer
- Division Pediatric Pathology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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2
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Infantile fibrosarcoma with an EGFR kinase domain duplication: Underlining a close relationship with congenital mesoblastic nephroma and highlighting a similar morphological spectrum. Ann Diagn Pathol 2022; 57:151885. [DOI: 10.1016/j.anndiagpath.2021.151885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
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3
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Davis JL, Al‐Ibraheemi A, Rudzinski ER, Surrey LF. Mesenchymal neoplasms with NTRK and other kinase gene alterations. Histopathology 2021; 80:4-18. [DOI: 10.1111/his.14443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Jessica L Davis
- Department of Pathology Oregon Health & Science University Portland OregonUSA
| | - Alyaa Al‐Ibraheemi
- Department of Pathology Boston Children’s Hospital Boston MassachusettsUSA
| | - Erin R Rudzinski
- Department of Laboratories Seattle Children’s Hospital Seattle WashingtonUSA
| | - Lea F Surrey
- Department of Pathology and Laboratory Medicine The Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
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4
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Surrey LF, Davis JL. NTRK-Rearranged soft tissue neoplasms: A review of evolving diagnostic entities and algorithmic detection methods. Cancer Genet 2021; 260-261:6-13. [PMID: 34794069 DOI: 10.1016/j.cancergen.2021.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/08/2021] [Accepted: 10/31/2021] [Indexed: 12/12/2022]
Abstract
The spectrum of tumors with NTRK1/2/3 rearrangements has expanded with widespread use of next generation sequencing (NGS) technology. For many years it was known that a majority of infantile fibrosarcomas (IFS), and their counterpart in the kidney, cellular congenital mesoblastic nephroma, contain the recurrent ETV6-NTRK3 fusion. Sequencing RNA transcripts from IFS and their morphologically similar counterparts in older children and adults has shown rearrangements with other 5' partners combined with NTRK1, NTRK2, and NTRK3 can also occur. For those tumors occurring outside of the infant age group, this has resulted in a proposed new diagnostic entity of "NTRK-rearranged spindle cell neoplasm." The clinical behavior of NTRK rearranged soft tissue tumors varies, though most show localized disease with rare metastases. The pathology of NTRK rearranged tumors exists on a spectrum, with overlapping features of classic infantile fibrosarcoma, lipofibromatosis, and malignant peripheral nerve sheath tumor. In this tumor spectrum, clinical and pathologic predictive factors are largely still to be determined, with no clear association between histologic grade and severity of disease. Of critical importance is detection of the NTRK rearrangement in order to guide treatment in patients with unresectable and metastatic disease. While resection is the definitive treatment, these tumors do show response to targeted TRK kinase inhibitors. Multiple detection methods are available, including immunohistochemistry, FISH, and next generation sequencing, which each have their merits and potential pitfalls. We aim to review the clinical characteristics and histomorphology of mesenchymal tumors with NTRK rearrangements as well as discuss molecular detection methods and diagnostic algorithms specific for soft tissue tumors.
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Affiliation(s)
- Lea F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jessica L Davis
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
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5
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Davis JL, Rudzinski ER. Pediatric and Infantile Fibroblastic/Myofibroblastic Tumors in the Molecular Era. Surg Pathol Clin 2021; 13:739-762. [PMID: 33183731 DOI: 10.1016/j.path.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric fibroblastic/myofibroblastic tumors are rare but include a wide variety of benign to malignant tumors. Given their uncommon frequency, they may present as a diagnostic dilemma. This article is focused on using clinical and pathologic clues in conjunction with the increasingly relevant and available molecular techniques to classify, predict prognosis, and/or guide treatment in these tumors.
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Affiliation(s)
- Jessica L Davis
- Department of Pathology, Oregon Health & Science University, L-471, Portland, OR 97239, USA.
| | - Erin R Rudzinski
- Department of Laboratories, Seattle Children's Hospital, OC.8.720, Seattle, WA 98105, USA
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6
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Larkin T, Qaysi NA, Mustafa MM, Lagmay J, Shenoy A. Primary mediastinal infantile fibrosarcoma: An unusual presentation involving the thymus. Pediatr Blood Cancer 2020; 67:e28402. [PMID: 32735378 DOI: 10.1002/pbc.28402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Trisha Larkin
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Nada Al Qaysi
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Moiz M Mustafa
- Division of Pediatric Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Joanne Lagmay
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Archana Shenoy
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
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7
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Abstract
BACKGROUND Infantile myofibromatiosis (IM) is a rare benign tumor in the infants, but it has a bad prognosis if IM erncroaches on the viscera. Multiple tissues can be invaded by IM, including the subcutaneous tissue, the muscle of the neck, back, and head, but seldom in the bones and the viscera. The histopathologic and immunohistochemical examinations are necessary in daigonosis of IM as it might be misdiagnosed as the malignant tumor. MATERIALS AND METHOD Thirty-two consecutive patients with IM in our hospital (2003-2013) were enrolled and the clinical date were analyzed to understand IM better, such as the feature of clinical manifestations, pathology, imaging tests, and treatment. RESULTS All of them underwent excision operations, 4 of them with invasion in the bones, 2 with invasion in the craniums, and the rest in the ulna and the humerus. The immunohistiochemical analysis shown that the tumor cells were positive to vimentin and smooth muscle actin while negative to the S100 protein and desmin. Twenty-five patients were in follow-up, 2 cases recurred. CONCLUSIONS IM is a benign tumor, but IM with the viscera involvement has a bad prognosis. The strategy of waiting and observation for IM without visceral involvement could be selected.
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8
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Abstract
Pediatric mesenchymal tumors harboring variant NTRK fusions (ETV6-negative) are being increasingly described; however, the histologic and clinical features of these variant NTRK tumors and their relationship to classic infantile fibrosarcoma are not well characterized. A better understanding of the clinicopathologic features of these tumors is necessary, and would aid in both early diagnosis and treatment. Therefore, the aim of this study was to characterize a series of pediatric NTRK-rearranged mesenchymal tumors, including classic ETV6-NTRK3 fused tumors and tumors with variant (non-ETV6) NTRK fusions. The clinical features, morphology, immunophenotype, and genetics of 12 classic ETV6-NTRK3 fused infantile fibrosarcoma and 18 variant NTRK-rearranged mesenchymal tumors were evaluated. For both classic and variant groups, the age at diagnosis ranged from birth to 15 years (median, 4 mo) with no sex predilection; the most common sites involved were the extremities and trunk. The rate of local recurrence and metastasis were not significantly different (recurrence rate: 11% classic, 40% variant; metastatic rate: 18% classic, 25% variant). Classic and variant NTRK tumors had an overlapping spectrum of histologic features, containing haphazardly arranged primitive cells in a myxoid background and/or spindle cells in long fascicles. Both groups showed diffuse pan-TRK expression by immunohistochemistry. Otherwise, the immunoprofile was nonspecific, but similar between both groups. No statistical difference was seen in any clinicopathologic feature between the classic ETV6-NTRK3 and variant fusion cohorts. Pediatric NTRK-rearranged mesenchymal tumors with both classic and variant fusions likely represent a spectrum of disease with shared, recognizable cliniopathologic features.
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9
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Hassan M, Butler E, Wilson R, Roy A, Zheng Y, Liem P, Rakheja D, Pavlick D, Young LL, Rosenzweig M, Erlich R, Ali SM, Leavey PJ, Parsons DW, Skapek SX, Laetsch TW. Novel PDGFRB rearrangement in multifocal infantile myofibromatosis is tumorigenic and sensitive to imatinib. Cold Spring Harb Mol Case Stud 2019; 5:mcs.a004440. [PMID: 31645346 PMCID: PMC6824247 DOI: 10.1101/mcs.a004440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/07/2019] [Indexed: 12/24/2022] Open
Abstract
Infantile myofibromatosis (IM) is an aggressive neoplasm composed of myofibroblast-like cells in children. Although typically localized, it can also present as multifocal disease, which represents a challenge for effective treatment. IM has previously been linked to activating somatic and germline point mutations in the PDGFRβ tyrosine kinase encoded by the PDGFRB gene. Clinical panel-based targeted tumor sequencing of a tumor from a newborn with multifocal IM revealed a novel PDGFRB rearrangement, which was reported as being of unclear significance. Additional sequencing of cDNA from tumor and germline DNA confirmed a complex somatic/mosaic PDGFRB rearrangement with an apparent partial tandem duplication disrupting the juxtamembrane domain. Ectopic expression of cDNA encoding the mutant form of PDGFRB markedly enhanced cell proliferation of mouse embryo fibroblasts (MEFs) compared to wild-type PDGFRB and conferred tumor-forming capacity on nontumorigenic 10T1/2 fibroblasts. The mutated protein enhanced MAPK activation and retained sensitivity to the PDGFRβ inhibitor imatinib. Our findings reveal a new mechanism by which PDGFRB can be activated in IM, suggest that therapy with tyrosine kinase inhibitors including imatinib may be beneficial, and raise the possibility that this receptor tyrosine kinase might be altered in a similar fashion in additional cases that would similarly present annotation challenges in clinical DNA sequencing analysis pipelines.
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Affiliation(s)
- Mohammed Hassan
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Erin Butler
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas 75235, USA
| | - Raphael Wilson
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Angshumoy Roy
- Baylor College of Medicine, Houston, Texas 77030, USA
| | - Yanbin Zheng
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Priscilla Liem
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Dean Pavlick
- Foundation Medicine, Inc, Cambridge, Massachusetts 02141, USA
| | - Lauren L Young
- Foundation Medicine, Inc, Cambridge, Massachusetts 02141, USA.,Beam Therapeutics, Cambridge, Massachusetts 02139, USA
| | - Mark Rosenzweig
- Foundation Medicine, Inc, Cambridge, Massachusetts 02141, USA
| | - Rachel Erlich
- Foundation Medicine, Inc, Cambridge, Massachusetts 02141, USA
| | - Siraj M Ali
- Foundation Medicine, Inc, Cambridge, Massachusetts 02141, USA
| | - Patrick J Leavey
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas 75235, USA
| | | | - Stephen X Skapek
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas 75235, USA
| | - Theodore W Laetsch
- Division of Hematology/Oncology, Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.,Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas 75235, USA
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10
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Abstract
Fibroblastic and myofibroblastic tumors comprise a morphologically diverse and biologically variable group of neoplasms that affect a wide age range. Specific entities tend to occur most frequently in infants and young children. Recent years have witnessed a proliferation of information concerning the unique biology of these tumors. In this report, I will review recent findings that serve to further characterize this group of neoplasms. Included will be newer information on fibrous hamartoma of infancy, infantile myofibromatosis, lipofibromatosis, and infantile fibrosarcoma and tumors resembling it, including primitive myxoid mesenchymal tumor of infancy and new genetic entities. I will also discuss the differential diagnosis, which includes spindle cell rhabdomyosarcoma, dermatofibrosarcoma protuberans, and calcifying aponeurotic fibroma.
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Affiliation(s)
- David M Parham
- Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pathology, USC Keck School of Medicine, Los Angeles, CA, USA
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11
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Davis JL, Lockwood CM, Albert CM, Tsuchiya K, Hawkins DS, Rudzinski ER. Infantile NTRK-associated Mesenchymal Tumors. Pediatr Dev Pathol 2018; 21:68-78. [PMID: 28683589 DOI: 10.1177/1093526617712639] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric fibroblastic/myofibroblastic lesions are a relatively common group of tumors with varying morphologies, for which the molecular mechanisms are becoming increasingly well characterized. Congenital infantile fibrosarcoma (CIFS), perhaps the most well studied of these lesions is characterized by a recurrent ETV6-NTRK3 gene fusion. However, a notable subset of locally aggressive congenital/infantile soft tissue lesions with similar morphologic features to CIFS, have not to-date, shown evidence of any canonical molecular aberration. We describe 6 patients with mesenchymal tumors composed of infiltrative fibroblastic/myofibroblastic tumor cells and showing a morphologic spectrum of features much analogous to that previously described in CIFS but without ETV6 fusion transcripts. These tumors lacked a uniform immunoprofile, but showed variable expression of CD34, S100, smooth muscle actin, and CD30. All patients first developed a mass in infancy (≤2 months of age). Using next-generation DNA sequencing, TMP3-NTRK1 fusions were identified in 4 cases, an LMNA-NTRK1 fusion in one case, and a variant EML4-NTRK3 fusion in one case. Similar to infantile fibrosarcoma, these tumors were locally aggressive (with local recurrences if incompletely excised) and rarely metastasized (lung metastases in one patient). Proper identification of these tumors including investigation for NTRK family gene rearrangements is essential for diagnostic accuracy, as well as for clinical management decisions. Given the morbidity associated with radical resection of large soft tissue tumors, children with unresectable, recurrent, and/or metastatic disease may benefit from treatment with NTRK targeted therapies.
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Affiliation(s)
- Jessica L Davis
- 1 Department of Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, California.,2 Department of Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Christina M Lockwood
- 3 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Catherine M Albert
- 4 Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karen Tsuchiya
- 2 Department of Pathology, Seattle Children's Hospital, Seattle, Washington.,3 Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Douglas S Hawkins
- 4 Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Erin R Rudzinski
- 2 Department of Pathology, Seattle Children's Hospital, Seattle, Washington
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12
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Ivanov A, Valyi-Nagy T, Nikas D. Extracalvarial Composite Infantile Myofibromatosis: Case Report and Literature Review. European J Pediatr Surg Rep 2016; 4:22-25. [PMID: 28018804 PMCID: PMC5177563 DOI: 10.1055/s-0036-1580704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/14/2016] [Indexed: 11/03/2022] Open
Abstract
Infantile soft tissue tumors of the head are very rare and the majority of them are myofibromas. The authors present the case of a 1-day-old boy with a scalp tumor with several distinct histopathological features including myofibroma, hemangiopericytoma, and fibrosarcoma consistent with the diagnosis of composite infantile myofibromatosis. Genetic testing was negative for trisomy 17, translocation (12; 15), FUS, and ETV6 translocations. Despite the ominous histopathological features, the clinical course was benign. The authors review here available literature concerning current concepts of making the diagnosis of composite infantile myofibromatosis and discuss treatment options.
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Affiliation(s)
- Alexander Ivanov
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Tibor Valyi-Nagy
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Dimitrios Nikas
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
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13
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Chest Wall Infantile Fibrosarcomas- A Rare Presentation. Indian J Surg Oncol 2016; 7:127-9. [PMID: 27065699 DOI: 10.1007/s13193-016-0487-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/05/2016] [Indexed: 02/05/2023] Open
Abstract
Infantile fibrosarcoma is rare and represents less than 1 % of all childhood cancers. Commonly, it arises in the limbs followed by the trunk and head and neck. We present a rare case of infantile fibrosarcoma of trunk at two different sites in a newborn with brief review of the relevant literature.
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14
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Henderson-Jackson EB, Bui MM. Molecular Pathology of Soft-Tissue Neoplasms and Its Role in Clinical Practice. Cancer Control 2016; 22:186-92. [PMID: 26068763 DOI: 10.1177/107327481502200209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Soft-tissue neoplasms embody a histologically diverse group of mesenchymal tumors. Oftentimes the histopathological diagnosis of soft-tissue tumors is challenging due to overlapping pathological features. METHODS We reviewed the current and most importantly known recurrent or tumor-specific genetic abnormalities involving soft-tissue tumors, focusing on how they are useful in working up differential diagnoses and the relevance of potentially targeted therapies. RESULTS Molecular diagnostic tools have shown great advantage as an aid in the differentiation between different soft-tissue tumor entities, providing a potential avenue in the identification of novel therapeutic targets. Gastrointestinal stromal tumor is a well-known example of a soft-tissue tumor with a successful, molecularly driven treatment with response rates of more than 80% in stable disease and partial remission. Classifying soft-tissue neoplasms by their molecular genetic pathology has been considered as molecular testing becomes more integrated into various diagnostic and prognostic algorithms. CONCLUSIONS Molecular pathology provides a unique opportunity for pathologists to play a crucial role in the multidisciplinary care of patients with sarcoma. These opportunities include but are not limited to the appropriate triage of tissue for molecular testing and the integration of molecular testing results, with histological and immunohistochemical findings providing actionable information for the diagnosis, prognosis, and choice of therapeutic modality.
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15
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Iwafuchi H, Tsuzuki T, Ito R, Miyake H, Okita H, Hamazaki M. Generalized infantile myofibromatosis with a monophasic primitive pattern. Pathol Int 2015; 65:432-7. [DOI: 10.1111/pin.12312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/21/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Hideto Iwafuchi
- Department of Pathology; National Center for Child Health and Development; Tokyo Japan
- Department of Pathology; Shizuoka Children's Hospital; Shizuoka Japan
| | - Toyonori Tsuzuki
- Department of Pathology; Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Rieko Ito
- Division of Hematology and Oncology; Shizuoka Children's Hospital; Shizuoka Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery; Shizuoka Children's Hospital; Shizuoka Japan
| | - Hajime Okita
- Department of Pathology; National Center for Child Health and Development; Tokyo Japan
- Department of Pathology; Keio University School of Medicine; Tokyo Japan
| | - Minoru Hamazaki
- Department of Pathology; Shizuoka Children's Hospital; Shizuoka Japan
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16
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Magro G, Salvatorelli L, Vecchio GM, Musumeci G, Rita A, Parenti R. Cytoplasmic expression of Wilms tumor transcription factor-1 (WT1): a useful immunomarker for young-type fibromatoses and infantile fibrosarcoma. Acta Histochem 2014; 116:1134-40. [PMID: 25005570 DOI: 10.1016/j.acthis.2014.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/16/2022]
Abstract
There is increasing evidence that Wilms' tumor transcription factor-1 (WT1) is expressed in the cytoplasm of neoplastic cells from different benign and malignant tumors. Only a few studies on WT1 cytoplasmic immunolocalization are available in pediatric tumors. The aim of the present study was to investigate immunohistochemically the expression and distribution of WT1 in a large series of soft tissue fibroblastic/myofibroblastic lesions occurring in children and adolescents. Notably WT1 was not expressed in nodular fasciitis and desmoid-type (adult) fibromatosis, while it stained diffusely and strongly in several infantile-type fibromatoses, such as fibrous hamartoma of infancy, myofibroma/myofibromatosis, and lipofibromatosis. Interestingly, WT1 cytoplasmic expression was also found in all cases (10/10) of infantile fibrosarcomas examined. The present study shows that a diffuse WT1 cytoplasmic expression is of complementary diagnostic value to conventional myofibroblastic markers (α-smooth muscle actin; desmin) in confirming diagnosis of young-type fibromatoses or infantile fibrosarcoma and in ruling out both desmoid-type fibromatoses and nodular fasciitis. WT1 cytoplasmic expression in infantile fibrosarcoma is a novel finding which could be exploitable as an immunomarker for this tumor. Although highly sensitive, WT1 cytoplasmic immunostaining is not specific for infantile fibrosarcoma, and thus it should be evaluated in the context of a wide immunohistochemical panel when pathologists are dealing with spindle cell lesions of soft tissues in children and adolescents. Accordingly we recommend that a correct diagnosis of fibroblastic/myofibroblastic soft tissue lesion in pediatric patients is usually achieved on the basis of a careful correlation of morphological and immunohistochemical findings in the appropriate clinical context. The different cellular localization of WT1, namely nuclear, cytoplasmic or nucleo-cytoplasmic, in different benign and malignant tumors supports the hypothesis that this transcription factor plays a complex role in tumorigenesis, likely as a chameleon protein functioning as either a tumor suppressor gene or an oncogene, depending on cellular context.
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Affiliation(s)
- Gaetano Magro
- Department G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" Anatomic Pathology, University of Catania, Catania, Italy.
| | - Lucia Salvatorelli
- Department G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" Anatomic Pathology, University of Catania, Catania, Italy
| | - Giada Maria Vecchio
- Department G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele" Anatomic Pathology, University of Catania, Catania, Italy
| | - Giuseppe Musumeci
- Department of Bio-Medical Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, Italy
| | - Alaggio Rita
- Department of Pathology, University of Padova, Padova, Italy
| | - Rosalba Parenti
- Department of Bio-Medical Sciences, Physiology Section, University of Catania, Catania, Italy
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17
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Cerrone M, Cantile M, Collina F, Marra L, Liguori G, Franco R, De Chiara A, Botti G. Molecular strategies for detecting chromosomal translocations in soft tissue tumors (review). Int J Mol Med 2014; 33:1379-91. [PMID: 24714847 PMCID: PMC4055444 DOI: 10.3892/ijmm.2014.1726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/29/2014] [Indexed: 02/07/2023] Open
Abstract
Approximately one third of soft tissue tumors are characterized by chromosomal aberrations, in particular, translocations and amplifications, which appear to be highly specific. The identification of fusion transcripts not only supports the diagnosis, but provides the basis for the development of novel therapeutic strategies aimed at blocking the aberrant activity of chimeric proteins. Molecular biology, and in particular, cytogenetic and qualitative and quantitative polymerase chain reaction technologies, allow with high efficiency and specificity, the determination of specific fusion transcripts resulting from chromosomal translocations, as well as the analysis of gene amplifications. In this review, various molecular techniques that allow the identification of translocations and consequent fusion transcripts generated are discussed in the broad spectrum of soft tissue tumors.
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Affiliation(s)
| | - Monica Cantile
- Pathology Unit, INT Pascale Foundation, I-80131 Naples, Italy
| | | | - Laura Marra
- Pathology Unit, INT Pascale Foundation, I-80131 Naples, Italy
| | | | - Renato Franco
- Pathology Unit, INT Pascale Foundation, I-80131 Naples, Italy
| | | | - Gerardo Botti
- Pathology Unit, INT Pascale Foundation, I-80131 Naples, Italy
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18
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Bridge JA. The role of cytogenetics and molecular diagnostics in the diagnosis of soft-tissue tumors. Mod Pathol 2014; 27 Suppl 1:S80-97. [PMID: 24384855 DOI: 10.1038/modpathol.2013.179] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 07/19/2013] [Indexed: 12/11/2022]
Abstract
Soft-tissue sarcomas are rare, comprising <1% of all cancer diagnoses. Yet the diversity of histological subtypes is impressive with >100 benign and malignant soft-tissue tumor entities defined. Not infrequently, these neoplasms exhibit overlapping clinicopathologic features posing significant challenges in rendering a definitive diagnosis and optimal therapy. Advances in cytogenetic and molecular science have led to the discovery of genetic events in soft-tissue tumors that have not only enriched our understanding of the underlying biology of these neoplasms but have also proven to be powerful diagnostic adjuncts and/or indicators of molecular targeted therapy. In particular, many soft-tissue tumors are characterized by recurrent chromosomal rearrangements that produce specific gene fusions. For pathologists, identification of these fusions as well as other characteristic mutational alterations aids in precise subclassification. This review will address known recurrent or tumor-specific genetic events in soft-tissue tumors and discuss the molecular approaches commonly used in clinical practice to identify them. Emphasis is placed on the role of molecular pathology in the management of soft-tissue tumors. Familiarity with these genetic events provides important ancillary testing for pathologists to include in their diagnostic armamentarium.
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Affiliation(s)
- Julia A Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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19
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Hu Z, Chou PM, Jennings LJ, Arva NC. Infantile fibrosarcoma-a clinical and histologic mimicker of vascular malformations: case report and review of the literature. Pediatr Dev Pathol 2013; 16:357-63. [PMID: 23718697 DOI: 10.2350/13-05-1335-cr.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infantile fibrosarcoma is a rare soft tissue tumor that usually presents either at birth or in the 1st year of life. Here we describe a case of a 4-month-old female who presented with a congenital right axillary mass. The initial clinical impression was benign vascular/lymphatic malformation. The core biopsy showed a spindle cell lesion with abundant vasculature represented by small vascular channels. However, immunohistochemical analysis did not support a diagnosis of vascular lesion/tumor. Polymerase chain reaction study for ETS Translocation Variant 6/neurotrophic tyrosine kinase receptor, type 3 fusion transcript was positive, and the diagnosis of infantile fibrosarcoma was established. The patient underwent resection of the axillary mass. Microscopic examination of the resection specimen showed numerous vascular channels. Intermixed there were also cellular areas composed of spindle cells similar to those seen in the biopsy material. Molecular studies were repeated and confirmed the diagnosis of infantile fibrosarcoma. Infantile fibrosarcoma has been previously reported in the literature to clinically masquerade as hemangioma. In addition, this case proves that infantile fibrosarcoma could also mimic vascular malformations on clinical, radiologic, and pathologic exams. In fact, the vascular component of the tumor is very unusual in our patient and represents a histologic feature that has not been described before. The case highlights the diagnostic challenges at clinical, radiologic, and pathologic levels in some cases of infantile fibrosarcoma and raises awareness among clinicians and pathologists related to another peculiar pattern that can be encountered in this disease.
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Affiliation(s)
- Zhihong Hu
- 1 Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, USA
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20
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Kim EJ, Wang KC, Lee JY, Phi JH, Park SH, Cheon JE, Jang YE, Kim SK. Congenital solitary infantile myofibromatosis involving the spinal cord. J Neurosurg Pediatr 2013; 11:82-6. [PMID: 23082913 DOI: 10.3171/2012.9.peds12245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infantile myofibromatosis, a rare mesenchymal disorder that develops in early childhood, is classified by the number of lesions that occur: solitary or multicentric. Involvement of the CNS is unusual in either type. Infantile myofibromatosis in the spine is exceptional, and most published cases represent a secondary invasion. Here, the authors report on an 8-month-old girl presenting with weakness below the ankle and an intraspinal mass extending from T-6 to the conus. The patient underwent only partial surgical removal of the lesion, and the pathology was confirmed as infantile myofibromatosis. After the operation, weakness in the lower extremities gradually improved; however, she could not walk at the time of the final follow-up. On follow-up MRI performed 19 months after the operation, the residual lesion remained unchanged with decreased enhancement.
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Affiliation(s)
- Eun Ji Kim
- Divisions of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Abstract
Fibroblastic and myofibroblastic tumors in children and adolescents are a relatively common group of soft tissue proliferations that range from reactive to hamartomatous to neoplastic, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic and immunohistochemical overlap, despite significant clinical, genetic, and prognostic differences. The fibromatoses are a major subgroup, and all types of fibromatoses can occur in the 1st 2 decades of life. Intermediate and malignant fibroblastic-myofibroblastic tumors are an important group that includes variants of fibrosarcoma and other tumors with recurrent cytogenetic or molecular genetic abnormalities and low metastatic potential. Pathologic examination is enhanced by adjunct techniques, such as immunohistochemistry, cytogenetics, and molecular genetics, although morphology provides the ultimate criteria for a specific diagnosis. This article reviews the clinicopathologic features of fibroblastic and myofibroblastic tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents, the use of diagnostic adjuncts, and differential diagnoses.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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22
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Oudijk L, den Bakker MA, Hop WCJ, Cohen M, Charles AK, Alaggio R, Coffin CM, de Krijger RR. Solitary, multifocal and generalized myofibromas: clinicopathological and immunohistochemical features of 114 cases. Histopathology 2012; 60:E1-11. [DOI: 10.1111/j.1365-2559.2012.04221.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Al-Salem AH. Congenital-infantile fibrosarcoma masquerading as sacrococcygeal teratoma. J Pediatr Surg 2011; 46:2177-80. [PMID: 22075353 DOI: 10.1016/j.jpedsurg.2011.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 07/29/2011] [Accepted: 08/19/2011] [Indexed: 11/26/2022]
Abstract
Infantile fibrosarcoma is rare and represents less than 1% of all childhood cancers. Commonly, it arises in the limbs followed by the trunk and head and neck. We report a rare case of infantile fibrosarcoma masquerading as sacrococcygeal teratoma in a newborn. The literature on the subject is also reviewed.
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Affiliation(s)
- Ahmed H Al-Salem
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, PO Box 61015, Qatif 31911, Saudi Arabia.
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Imafuku S, Takahashi A, Hashizumi Y, Sasamoto K, Tokumaru R, Iwasaki H, Nakayama J. Cranial fasciitis resembling infantile fibrosarcoma differentiated by genetic assay. J Dermatol 2011; 38:1006-9. [PMID: 21366679 DOI: 10.1111/j.1346-8138.2010.01161.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Green MC, Dorfman HD, Villanueva-Siles E, Gorlick RG, Thornhill BA, Weber RV, Geller DS. Aggressively recurrent infantile myofibroma of the axilla and shoulder girdle. Skeletal Radiol 2011; 40:357-61. [PMID: 20978757 DOI: 10.1007/s00256-010-1056-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/06/2010] [Accepted: 10/08/2010] [Indexed: 02/02/2023]
Abstract
Infantile myofibroma is the most common fibrous tumor of infancy, typically affecting neonates and children under 2 years of age. Though the multicentric variant portends a grave prognosis, solitary lesions have an excellent prognosis and frequently undergo spontaneous regression. Surgical excision of solitary lesions is usually curative. In this report, we describe a pediatric patient with an unusually aggressive solitary myofibroma of the axilla who ultimately required a forequarter amputation as a lifesaving measure following multiple tumor recurrences and progressive tumor growth. The clinical course, radiographic findings, histology, and management rationale are presented.
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Affiliation(s)
- Matthew C Green
- Montefiore Medical Center, 429 Third Avenue, Pelham, NY 10803, USA.
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26
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Behnke NM, Patel M, Davidson T, Arkader A. Orthopaedic case of the month: Rapidly progressive shoulder soft tissue mass in an 8-week-old girl. Clin Orthop Relat Res 2011; 469:624-9. [PMID: 21128034 PMCID: PMC3018191 DOI: 10.1007/s11999-010-1710-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 11/17/2010] [Indexed: 01/31/2023]
Affiliation(s)
- Nicole Marie Behnke
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA USA
| | - Moneil Patel
- Department of Pathology, Keck School of Medicine, University of Southern California, Children’s Hospital of Los Angeles, Los Angeles, CA USA
| | - Tom Davidson
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children’s Hospital of Los Angeles, Los Angeles, CA USA
| | - Alexandre Arkader
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Children’s Hospital of Los Angeles, 4650 W Sunset Boulevard, Mailstop #69, Los Angeles, CA 90027 USA
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Abstract
Pediatric myofibroblastic tumors comprise a clinically and pathologically heterogeneous group of neoplasms, including benign tumors, those of intermediate biologic potential, and frankly malignant examples (Box 1). Proper classification is critical for appropriate prognostication, clinical management, and, in some cases, identification of familial syndromes. Unlike for many other soft tissue tumors, immunohistochemistry plays a limited role in the diagnosis of pediatric myofibroblastic tumors, with notable exceptions. Understanding the molecular genetics underlying the pathogenesis of several tumor types in this group has led to improved tools for diagnosis. This article discusses the clinical and pathologic features of myofibroblastic tumors in children, with special emphasis on differential diagnosis.
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Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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