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Cassalia F, Cavallin F, Danese A, Del Fiore P, Di Prata C, Rastrelli M, Belloni Fortina A, Mocellin S. Soft Tissue Sarcoma Mimicking Melanoma: A Systematic Review. Cancers (Basel) 2023; 15:3584. [PMID: 37509250 PMCID: PMC10377019 DOI: 10.3390/cancers15143584] [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: 06/20/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Sarcoma may show similarities to malignant melanoma in terms of morphologic and immunohistochemical aspects, making it difficult to differentiate between these two neoplasms during the diagnostic process. This systematic review aims to summarize available evidence on cases of sarcoma that were initially diagnosed as melanoma. METHODS A comprehensive search of the MEDLINE/Pubmed, EMBASE, and SCOPUS databases was conducted through March 2023. We included case series and case reports of sarcoma patients that were initially diagnosed as malignant melanoma. PRISMA guidelines were followed. RESULTS Twenty-three case reports and four case series with a total of 34 patients were included. The clinical presentation was heterogeneous, and the most involved anatomical regions were lower limbs (24%), head/neck (24%), and upper limbs (21%). IHC positivity was reported for S100 (69%), HMB45 (63%), MelanA (31%), and MiTF (3%). The main reasons for a second assessment were unusual presentation (48%) and uncertain diagnosis (28%). EWSR1 translocation was investigated in 17/34 patients (50%) and found to be positive in 16/17 (94%). The final diagnosis was clear cell sarcoma (50%) or other soft tissue sarcomas (50%). CONCLUSIONS Melanoma and some histotypes of sarcoma share many similarities. In cases of atypical lesions, a second diagnosis should be considered, and ESWR1 translocation should be investigated.
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Affiliation(s)
- Fortunato Cassalia
- Unit of Dermatology, Department of Medicine, University of Padua, 35121 Padua, Italy
| | | | - Andrea Danese
- Unit of Dermatology, Department of Integrated Medical and General Activity, University of Verona, 37100 Verona, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Claudia Di Prata
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padua, Italy
| | - Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padua, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padua, Italy
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Muacevic A, Adler JR, Elmernissi FZ, Elfatemi H, Chbani L. Clear-Cell Sarcoma With an Unusual Presentation Mimicking Metastatic Melanoma. Cureus 2022; 14:e32010. [PMID: 36589177 PMCID: PMC9798674 DOI: 10.7759/cureus.32010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
Clear-cell sarcoma (CCS) was first described in 1968. It partly overlaps morphologically, immunohistochemically, and ultrastructurally with malignant melanoma (MM), hence its name "soft tissue melanoma." Nevertheless, there are sufficient cytogenetic differences between cutaneous melanoma and clear-cell sarcoma to consider clear-cell sarcoma as a separate entity. Clear-cell sarcoma of soft tissue is different from clear-cell sarcoma of the kidney. It is classified as a tumor of uncertain differentiation in the WHO 2020 classification of soft tissue tumors. It is an aggressive, rare malignant tumor that is involved in the deep soft tissues of the extremities and trunk. We report a case of primary clear-cell sarcoma of unusual presentation in a 31-year-old young man, mimicking metastatic melanoma. A 31-year-old man presented with a heel mass of 2.5 cm. Histologically, it was a dermal and hypodermal nodular proliferation of spindle cells of 23 mm with a grenz zone under the epidermis. There was no necrosis area or lymphovascular invasion. Surgical margins were free. There were no clinically suspicious lymph nodes. The tumor cells were stained for S100 protein, MELAN A, and HMB45, which led to an initial diagnosis of metastatic malignant melanoma. However, analysis by fluorescence in situ hybridization (FISH) found a rearrangement of the Ewing sarcoma region 1 (EWSR1) gene, which led to a diagnosis of primary clear cell sarcoma in the skin. This case highlights the importance of considering the diagnosis of a clear-cell sarcoma in front of any dermal lesions with morphological and immunohistochemical melanocytic features that do not have an in situ component and of atypical presentation, especially in young patients, hence the interest in performing fluorescence in situ hybridization for EWSR1, which remains the key to the diagnosis of cutaneous clear-cell sarcoma.
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Skalova A, Leivo I, Hellquist H, Simpson RHW, Vander Poorten V, Willems SM, Mosaieby E, Slouka D, Ferlito A. Clear Cell Neoplasms of Salivary Glands: A Diagnostic Challenge. Adv Anat Pathol 2022; 29:217-226. [PMID: 35249992 DOI: 10.1097/pap.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review focuses on the heterogenous group of clear cell neoplasms of salivary glands and attempts to identify major differential diagnostic features. Within the head and neck region, clear cells are found most commonly in salivary gland tumors, but may also be seen in tumors of squamous or odontogenic epithelial origin, primary or metastatic carcinomas, benign or malignant melanocytic lesions, or benign or malignant mesenchymal tumors. Clear cells occur fairly commonly among a wide variety of salivary gland neoplasms, but mostly they constitute only a minor component of the tumor cell population. Clear cells represent a major diagnostic feature in two salivary gland neoplasms, epithelial-myoepithelial carcinoma and hyalinizing clear cell carcinoma. In addition, salivary gland neoplasms composed predominantly of clear cells could also include clear cell variants of other salivary neoplasms, such as mucoepidermoid carcinoma and myoepithelial carcinoma, but their tumor type-specific histologic features may only be available in limited nonclear cell areas of the tumor. Diagnosing predominantly clear cell salivary gland tumors is difficult because the immunoprofiles and morphologic features may overlap and the same tumor entity may also have a wide range of other histologic presentations. Many salivary gland tumors are characterized by tumor type-specific genomic alterations, particularly gene fusions of the ETV6 gene in secretory carcinoma, the MYB and MYBL1 genes in adenoid cystic carcinoma, the MAML2 gene in mucoepidermoid carcinoma, the EWSR1 gene in hyalinizing clear cell carcinoma, and others. Thus, along with conventional histopathologic examination and immunoprofiling, molecular and genetic tests may be important in the diagnosis of salivary gland clear cell tumors by demonstrating genetic alterations specific to them.
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Affiliation(s)
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Department of Biomedical Sciences and Medicine, Algarve Biomedical Center (ABC), University of Algarve, Faro, Portugal
| | - Roderick H W Simpson
- Department of Anatomical Pathology, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Elaheh Mosaieby
- Departments of Pathology
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, Czech Republic
| | - David Slouka
- Otorhinolaryngology, Faculty of Medicine in Plzen, Charles University
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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4
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Sasaki M, Tanaka M, Asukai K, Koguchi H, Inoue Y, Moriyama M, Tsukahara T, Kawahara T, Hayashi E, Hattori Y, Hasegawa I, Kataoka H. Malignant gastrointestinal neuroectodermal tumor presenting with small intestinal obstruction: A case report. DEN OPEN 2022; 2:e119. [PMID: 35873522 PMCID: PMC9302053 DOI: 10.1002/deo2.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
Abstract
Malignant gastrointestinal neuroectodermal tumors (GNETs) are rare malignant mesenchymal neoplasms. To our knowledge, only 99 cases have been reported worldwide. The tumor has an aggressive malignancy, with a rapid progression. The histological features of GNET overlap with those of clear cell sarcoma, which contain Ewing sarcoma breakpoint region 1 mutation. GNETs lack melanocyte‐specific markers, while clear cell sarcoma exhibits melanocytic differentiation. Various symptoms have been reported previously, and the most reported lesion is in the small bowel. The patient was a 69‐year‐old man who presented with abdominal pain and vomiting. Computed tomography revealed a nodule in the small bowel, which induced small intestinal obstruction. Enteroscopic images revealed a submucosal tumor. Surgery was performed, and the patient was diagnosed with GNET. Only two patients whose primary lesions were in the small intestine, including the patient in this report, have undergone enteroscopy before surgery. This is a rare case of GNET in which a patient underwent enteroscopy before surgical treatment.
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Affiliation(s)
- Makiko Sasaki
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Science Aichi Japan
| | - Mamoru Tanaka
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Science Aichi Japan
| | - Koki Asukai
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Hiroki Koguchi
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Yusuke Inoue
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Mizuki Moriyama
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
- Department of Surgery Kasugai Municipal Hospital Aichi Japan
| | - Tetsuo Tsukahara
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
- Department of Surgery Anjo Kosei Hospital Aichi Japan
| | - Takeo Kawahara
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Eiji Hayashi
- Department of Surgery Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Yukinori Hattori
- Department of Pathology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Izumi Hasegawa
- Department of Gastroenterology Japan Community Health Care Organization Chukyo Hospital Aichi Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Science Aichi Japan
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Sidlik Muskatel R, Pillar N, Godefroy J, Lotem M, Goldstein G. Case report: Robust response of metastatic clear cell sarcoma treated with cabozantinib and immunotherapy. Front Pediatr 2022; 10:940927. [PMID: 36275056 PMCID: PMC9582433 DOI: 10.3389/fped.2022.940927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Clear Cell Sarcoma (CCS), also referred to as malignant melanoma of soft parts, is a rare and aggressive malignant tumor. It comprises 1% of all soft tissue sarcomas and is known to be radio- and chemotherapy resistant. CCS shares morphological and immunohistochemical features with malignant melanoma, including melanin biosynthesis and melanocytic markers. However, it is distinct for the presence of EWSR1-ATF1 translocation which activates MITF transcription factor. We report here of an aggressive case of CCS in a 9-year-old patient, which demonstrates the critical role of molecular analysis in the diagnosis and treatment of uncommon cancer variants in the era of personalized medicine. The EWSR1-ATF1 translocation induces pathological c-Met activation, and so, following unsuccessful CTLA4 and PD-1 blockade immunotherapy, the child received cabozantinib, a small molecule tyrosine kinase inhibitor, with the intent to block c-Met oncogenic effect. In parallel, active immunization, using hapten di-nitrophenyl modified autologous tumor cells was administered with monotherapy PD-1 inhibitor nivolumab. Under this "triplet" therapy, the patient attained an initial partial response and was progression-free for 2 years, in good performance status and resumed schooling. Based on our observation, cabozantinib can be used as an effective and potentially life-prolonging treatment in CCS. We suggest that priming the child's immune system using her autologous tumor and combating T cell exhaustion with PD-1 blockade may have synergized with the targeted therapy. Combining targeted and immunotherapy is a rapidly growing practice in solid tumors and provides a glimpse of hope in situations that previously lacked any treatment option.
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Affiliation(s)
- Rakefet Sidlik Muskatel
- The Dyna and Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nir Pillar
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jeremy Godefroy
- Hadassah Hebrew University Medical Center, Nuclear Medicine Institute, Jerusalem, Israel
| | - Michal Lotem
- Center for Melanoma and Cancer Immunotherapy, Hadassah Hebrew University Medical Center, Sharett Institute of Oncology, Jerusalem, Israel
| | - Gal Goldstein
- The Dyna and Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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A Smooth, Round Nodule on the Right Foot: Answer. Am J Dermatopathol 2021; 43:533-535. [PMID: 34140443 DOI: 10.1097/dad.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Atypical clear cell sarcoma of the pleura presenting as large pleural effusion with 22q12 abnormality: A challenging case with twists and turns. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Bonatskaya AA, Minaeva AE, Vinogradov II. [Soft tissue clear cell sarcoma. A report of three cases]. Arkh Patol 2021; 83:35-39. [PMID: 34041894 DOI: 10.17116/patol20218303135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paper describes three cases of soft tissue clear cell sarcoma, a rare melanin-producing malignant tumor, which is diagnosed in 52-to-87-year-old women. It provides a clinical and morphological description of the tumor and the results of immunohistochemical tests.
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Affiliation(s)
| | - A E Minaeva
- Pavlov Ryazan State Medical University, Ryazan, Russia
| | - I I Vinogradov
- Pavlov Ryazan State Medical University, Ryazan, Russia.,Regional Clinical Oncology Dispensary, Ryazan, Russia
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Zhu P, Zhang T, Bi K, Wu Y, Chen X, Zhang H, Huang D, Zhang L, Zeng Y, Yi X. Primary Clear Cell Sarcoma of the Ileum: A Case Report With Next-Generation Sequencing Analysis. Int J Surg Pathol 2021; 29:677-684. [PMID: 33412984 DOI: 10.1177/1066896920985311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the concept of clear cell sarcoma-like tumor or malignant gastrointestinal neuroectodermal tumor (CCS-LT/MGNET) has been widely accepted, primary CCS of the gastrointestinal tract (CCS-GI) is becoming a rare entity. In this article, we describe a case of primary CCS-GI that occurred in the ileum of a 65-year-old male to further illustrate its rare occurrence. Similar to CCS of soft tissue (CCS-ST), the tumor was composed of spindled to epithelioid cells displaying fascicular, nested, or pseudopapillary arrangement. The tumor cells had large round to ovoid nuclei with vesicular chromatin and prominent nucleoli, containing eosinophilic to pale cytoplasm. In contrast to CCS-LT/MGNET, immunohistochemical study also showed variable positivity of HMB45, melan A, and MiTF besides the strong and diffuse staining of S100 protein and SOX10. Fluorescence in situ hybridization (FISH) using fusion probes identified EWSR1 and ATF1 genes rearrangement. Next-generation sequencing (NGS) analysis further revealed EWSR1 exons9/8-ATF1 exon4 and ATF1 exon3- EWSR1 exon11 fusion genes. CCS-GI and CCS-LT/MGNET possibly represent 2 related entities of the same spectrum, which differentiate along 2 different pathways.
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Affiliation(s)
- Peipei Zhu
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Zhang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ke Bi
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunjin Wu
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue Chen
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haoyang Zhang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dandan Huang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Zhang
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Zeng
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xianghua Yi
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Clear Cell Sarcoma of the Foot in an 18-Year-Old Female. Case Rep Orthop 2019; 2019:8378106. [PMID: 31871807 PMCID: PMC6906827 DOI: 10.1155/2019/8378106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 12/02/2022] Open
Abstract
We report a case of an 18-year-old female without a relevant medical history who presented with an 8-month history of a left foot mass. It started as a small nodule that progressively increased in size over time. The mass then became ulcerative with foul-smelling discharge. There was no palpable left inguinal or other lymph nodes upon physical examination. Histological examination of the biopsy confirmed a diagnosis of clear cell sarcoma. Clear cell sarcoma is a rare soft tissue neoplasm. However, early diagnosis is crucial to prevent metastasis and worsened prognosis. Clear cell sarcoma has an extremely poor prognosis once metastasis occurs, and to the best of our knowledge, only fewer than 100 cases have been reported in the literature.
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