A Comparison of Clear Cell Sarcoma to Jaw and Salivary Tumors Bearing EWS Fusions

OBJECTIVE

To review tumors identified as "clear cell sarcoma" in order to determine similarities to the rare EWS fusion positive jaw and salivary gland tumors clear cell odontogenic carcinoma (CCOC) and clear cell carcinoma of the salivary gland (CCC).

METHODS

PubMed was used to collect all reports of clear cell sarcoma (CCS). Search parameters were "clear cell sarcoma" and "CCS." References in the publications were screened and cross-referenced. Data extracted included demographic characteristics, presenting signs and symptoms, radiographic findings, histological and immunohistochemical features and known molecular/genetic aberrations.

RESULTS

Clear cell sarcoma has several similarities to CCOC and CCC. All three tumor types have similar histologic appearances including the presence of clear cells, as well as similar genetic profiles in that all harbor an EWSR1-CREB family fusions. Additionally, these tumors appear in soft tissue as well as bone, and can have a prolonged clinical course. CCS can appear anywhere in the body, including the head and neck region. All three tumors appear to have a predilection to women, although CCS may have a slight younger age of onset as compared to CCOC and CCC (3rd vs 5th decade of life, respectively).

CONCLUSION

Gaining a better understanding of the similarities and differences between these three tumors may lead to a better understanding of each one.

Clear cell carcinoma: a comprehensive literature review of 254 cases

This comprehensive literature review represents a summary of all cases of clear cell carcinoma (CCC) of the salivary glands that are documented in the literature. PubMed was used to collect available reports of CCC; 97 reports detailing 254 cases, published between 1983 and 2020, were retrieved. Clinically the tumor manifests most commonly as a painless mass or swelling on the palate, and the duration of symptoms prior to seeking care ranges from 1 week to 6 years. Local tumor recurrence was present in 18.8% of the cases. By histopathology, CCC shows a mixture of growth patterns including solid (25.1%), nested (78.6%), sheet-like (23.5%), cords (46.1%), and trabeculae (42.4%). Immunohistochemical studies are positive for one or more cytokeratins (99.1%), PAS (95.1%), EMA (77.8%), and p63 (96.3%), but negative for S-100 (96.3%), PASD (91.1%), SMA (91.0%), and calponin (95.1%). Molecular features were reported in 113 cases; 96.0% were positive for an EWSR1 rearrangement by EWSR1 break apart FISH testing and 14.8% were positive for the rearrangement EWSR1-ATF1 tested by qPCR or targeted RNA sequencing. Clinical patterns and genetic studies imply that this tumor is the extraosseous counterpart of clear cell odontogenic carcinoma, an intraosseous odontogenic tumor of the jaws.

Measurements of medication adherence in diabetic patients with poorly controlled HbA(1c)

AIMS

To assess pharmacy claims and self-report data as measures of medication adherence and to describe baseline characteristics of subjects in the Improving Diabetes Outcomes Study.

METHODS

Multi-ethnic, lower-income, insured adults (n = 526) in New York City with Type 2 diabetes were enrolled in a randomized, controlled, behavioural intervention study delivered by telephone. Baseline data were examined, including glycated haemoglobin (HbA(1c)), objective measures of diabetes medication adherence [claims data medication possession ratio (MPR)], and two self-report measures [Morisky Medication-taking Scale and the medication-taking item of the Summary of Diabetes Self-Care Activities (SDSCA)]. Associations of highest tertile HbA(1c) (>or= 9.3%) with lowest tertile MPR (< 42%) were assessed with logistic regression models adjusting for potential confounders. Subset analyses were performed based on assessment of potential interaction.

RESULTS

Participants (mean +/- sd age 56 +/- 7 years) had median (interquartile range) HbA(1c) 8.6% (8.0-10.0). Correlations of baseline MPR with Morisky score and SDSCA medication-taking item were strongly significant (both rho = 0.21, P < 0.001). Lowest MPR was significantly (P = 0.008) associated with highest HbA(1c) in the group as a whole and among the subset taking two or more oral glucose-lowering agents (OGLA) (P = 0.002), but not among the subset taking only one (P = 0.83). Self-report adherence measures were not significantly associated with HbA(1c) in either the whole group or either subset.

CONCLUSIONS

These results support the validity of MPR as an adherence measure for OGLA among insured diabetes patients with poorly controlled HbA(1c), especially those taking two or more OGLA.