Sclerosing Epithelioid Fibrosarcoma of the Coccyx: A Case Report and Review of Literature

Sclerosing Epithelioid Fibrosarcoma of the Spine: Diagnosis and Treatment of a Rare Entity

Sclerosing epithelioid fibrosarcoma (SEF) is a rare subtype of sarcoma with high rates of local recurrence and distant metastasis. Morphologically, it resembles other mesenchymal and non-mesenchymal tumors, making it a diagnostic challenge. Treatment relies mostly on surgery with adjuvant chemotherapy or radiotherapy (RT). A 46-year-old woman who presented with lumbar pain and weight loss underwent a computed tomography (CT) scan, magnetic resonance imaging (MRI), and a [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan, which showed a lesion involving the L5 vertebra. An incisional biopsy of the lesion established the diagnosis of SEF, with diffuse expression of MUC4 and focal expression of EMA. The patient was treated with neoadjuvant RT followed by surgery. Histology was congruent with the previous diagnosis and demonstrated post-radiation changes. In conclusion, SEF is an aggressive type of sarcoma that is easily misdiagnosed, so it is important to consider it in the differential diagnosis to avoid unbeneficial treatments and a detriment to patient survival.

Metastatic Pediatric Sclerosing Epithelioid Fibrosarcoma

Sclerosing epithelioid fibrosarcoma (SEF) is a rare and aggressive soft-tissue sarcoma thought to originate in fibroblasts of the tissues comprising tendons, ligaments, and muscles. Minimally responsive to conventional cytotoxic chemotherapies, >50% of SEF patients experience local recurrence and/or metastatic disease. SEF is most commonly discovered in middle-aged and elderly adults, but also rarely in children. A common gene fusion occurring between the EWSR1 and CREB3L1 genes has been observed in 80%–90% of SEF cases. We describe here the youngest SEF patient reported to date (a 3-yr-old Caucasian male) who presented with numerous bony and lung metastases. Additionally, we perform a comprehensive literature review of all SEF-related articles published since the disease was first characterized. Finally, we describe the generation of an SEF primary cell line, the first such culture to be reported. The patient described here experienced persistent disease progression despite aggressive treatment including multiple resections, radiotherapy, and numerous chemotherapies and targeted therapeutics. Untreated and locally recurrent tumor and metastatic tissue were sequenced by whole-genome, whole-exome, and deep-transcriptome next-generation sequencing with comparison to a patient-matched normal blood sample. Consistent across all sequencing analyses was the disease-defining EWSR1–CREB3L1 fusion as a single feature consensus. We provide an analysis of our genomic findings and discuss potential therapeutic strategies for SEF.

The rare primary bone sarcomas: imaging-pathological correlation

Rare primary bone sarcomas are challenging entities both radiologically and pathologically. These include the diagnoses of spindle cell sarcoma (leiomyosarcoma, fibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor), pleomorphic liposarcoma, and undifferentiated pleomorphic sarcoma. The radiographic and cross-sectional imaging features of each of these tumors are presented, along with current key pathological concepts. Frequently non-specific, the radiological appearances must be correlated with all clinical and pathological information available to enable an accurate diagnosis.

Imaging Features of Sclerosing Epithelioid Fibrosarcoma of the Pancreas: A Case Report

Background: Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare fibrosarcoma variant. There is no complete imaging data on SEF involving the pancreas. Herein we report the computed tomography (CT) and magnetic resonance imaging (MRI) data of a patient with SEF that primarily involved the pancreas.

Case Presentation: A 64-year-old man was found to have a solid mass in the tail of the pancreas on unenhanced CT. He had no constitutional symptoms. Contrast-enhanced abdominal CT and MRI were performed, and the results of the latter provided the diagnosis of a pancreatic neuroendocrine tumor. Laparoscopic distal pancreatectomy and splenectomy were performed. Anatomopathological examination and immunohistochemistry confirmed that the tumor was a SEF of the pancreas. The patient had no signs of recurrence or metastasis during a 12-months follow-up.

Conclusion: We report an extremely rare case of SEF in the pancreas and its characterization with CT and MRI.