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Jain E, Munjal G, Sharma S, Brar Z, Bhardwaj N, Dewan A, Jain D, Jha S, Lobo A, Malik V, Arora S, Varshney J, Beg A, Sampat NY, Parwani AV, Balzer B, Varma M, Yadav BS, Sharma SK, Singh HP, Gogoi K, Kumar D, Bhandari V, Fulara LM, Kumar A, Singh H, Bhattacharya M, Dixit M, Mohanty SK. Multifaceted Spindle Cell/Sclerosing Rhabdomyosarcoma With Role of Immunohistochemistry in Avoiding Misdiagnosis: A Multi-Institutional Study of 45 Distinct Tumors. Int J Surg Pathol 2024; 32:496-506. [PMID: 37489265 DOI: 10.1177/10668969231188422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background. Spindle cell/sclerosing rhabdomyosarcoma is a rare neoplasm and has an aggressive clinical course. Because of its rarity, we performed a multi-institutional collaboration to comprehend the overarching clinical, histopathological, and immunohistochemical characteristics of a cohort of spindle cell/sclerosing rhabdomyosarcoma. Materials and Methods. Forty-five patients with spindle cell/sclerosing rhabdomyosarcoma were identified. Demographics, clinical, histopathological, and immunohistochemistry data were reviewed and recorded. Results. The patients' age ranged from 1 to 85 years with a male to female ratio of 1.2:1. There were 15 children/adolescents and 30 adults. Eighteen (40%) tumors were located in the head and neck region. Twenty-four (53%) tumors displayed a bimorphic cellular arrangement with hypercellular areas having short, long, and sweeping fascicular and herringbone pattern, and hypocellular areas with stromal sclerosis and associated hyalinized and/or chondromyxoid matrix. Histomorphological differentials considered were leiomyosarcoma, malignant peripheral nerve sheath tumor, fibrosarcoma, nodular fasciitis, liposarcoma, synovial sarcoma, sarcomatoid carcinoma, solitary fibrous tumor, dermatofibrosarcoma protuberans, and schwannoma. Six tumors exhibited marked stromal sclerosis. The myogenic nature was confirmed by immunohistochemistry. Positivity for at least one skeletal muscle-associated marker (MyoD1 and/or myogenin) was observed. Conclusion. Spindle cell/sclerosing rhabdomyosarcoma diagnosis can be challenging as a number of malignant spindle cell neoplasm mimic this entity. Thus a correct diagnosis requires immunohistochemical work up with a broad panel of antibodies. In view of rarity of this neoplasm, further studies on a large cohort of patients with clinical follow-up data are needed for a better understanding of this tumor.
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Affiliation(s)
- Ekta Jain
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Gauri Munjal
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Shivani Sharma
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Zoya Brar
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Nitin Bhardwaj
- Indian Council of Medical Research and National Institute of Malaria Research, New Delhi, India
| | - Aditi Dewan
- BLK-MAX Superspeciality Hospital, New Delhi, India
| | - Deepika Jain
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Shilpy Jha
- Advanced Medical and Research Institute, Bhubaneshwar, India
| | - Anandi Lobo
- Kapoor Pathology and Urology Centre, Raipur, India
| | - Vipra Malik
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Samriti Arora
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Juhi Varshney
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Arshi Beg
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Nakul Y Sampat
- Advanced Medical and Research Institute, Bhubaneshwar, India
| | - Anil V Parwani
- Wexner Medical Center, Department of Pathology, The Ohio State University, Columbus, OH, USA
| | | | - Monica Varma
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Brijpal S Yadav
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | | | - Hena Paul Singh
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Kamakhya Gogoi
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Devendra Kumar
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | | | - Lalit M Fulara
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Arvind Kumar
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Harish Singh
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | | | - Mallika Dixit
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
| | - Sambit K Mohanty
- Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India
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2
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Lobo A, Mishra SK, Jha S, Tiwari A, Kapoor R, Sharma S, Kaushal S, Kiranmai NS, Das MR, Peddinti KP, Sharma SK, Bhardwaj N, Arora S, Jain D, Jain E, Munjal G, Shinde S, Malik V, Singh H, Varshney J, Pradhan D, Dixit M, Pattnaik N, Sharma AK, Barapatre YR, Pradhan M, Satapathy K, Rath D, Jaiswal S, Das S, Khadenga C, Routa S, Baisakh MR, Tiwari R, Sampat NY, Chakrabarti I, Parwani AV, Mohanty SK. Evaluation of programmed cell death ligand 1 expression in a contemporary cohort of penile squamous cell carcinoma and its correlation with clinicopathologic and survival parameters: A study of 134 patients. Am J Clin Pathol 2024; 161:49-59. [PMID: 37639681 DOI: 10.1093/ajcp/aqad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Penile squamous cell carcinomas (PCs) are rare malignancies with a dismal prognosis in a metastatic setting; therefore, novel immunotherapeutic modalities are an unmet need. One such modality is the immune checkpoint molecule programmed cell death ligand 1 (PD-L1). We sought to analyze PD-L1 expression and its correlation with various clinicopathologic parameters in a contemporary cohort of 134 patients with PC. METHODS A cohort of 134 patients with PC was studied for PD-L1 immunohistochemistry. The PD-L1 expression was evaluated using a combined proportion score with a cutoff of 1 or higher to define positivity. The results were correlated with various clinicopathologic parameters. RESULTS Overall, 77 (57%) patients had positive PD-L1 expression. Significantly high PD-L1 expression was observed in high-grade tumors (P = .006). We found that 37% of human papillomavirus (HPV)-associated subtypes and 73% of other histotype tumors expressed PD-L1, while 63% of HPV-associated tumors and 27% of other histotype tumors did not (odds ratio, 1.35; P = .002 when compared for HPV-associated groups vs all others). Similarly, PD-L1-positive tumors had a 3.61-times higher chance of being node positive than PD-L1-negative tumors (P = .0009). In addition, PD-L1 high-positive tumors had a 5-times higher chance of being p16ink4a negative than PD-L1 low-positive tumors (P = .004). The PD-L1-positive tumors had a lower overall survival and cancer-specific survival than PD-L1-negative tumors. CONCLUSIONS Overall, PD-L1 expression is associated with high-grade and metastatic tumors. Lower PD-L1 expression is observed more frequently in HPV-associated (warty or basaloid) subtypes than in other, predominantly HPV-independent types. As a result, PD-L1 positivity, including higher expression, portends lower overall and cancer-specific survival. These data provide a rational for further investigating PD-L1-based immunotherapeutics in PC.
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Affiliation(s)
- Anandi Lobo
- Department of Pathology and Laboratory Medicine and Urology, Kapoor Centre of Urology and Pathology, Raipur, India
| | - Sourav K Mishra
- Department of Medical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Shilpy Jha
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Ankit Tiwari
- Cold Spring Harbor Borniger Laboratory, New York, NY, US
| | - Rahul Kapoor
- Department of Pathology and Laboratory Medicine and Urology, Kapoor Centre of Urology and Pathology, Raipur, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Seema Kaushal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | - Nitin Bhardwaj
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Samriti Arora
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Deepika Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Gauri Munjal
- Department of Pathology and Laboratory Medicine, Pathkind Laboratories, Gurgaon, India
| | - Sayali Shinde
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Vipra Malik
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Hena Singh
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Juhi Varshney
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Dinesh Pradhan
- Department of Pathology and Laboratory Medicine, Sonic Healthcare, Jacksonville, FL, US
| | - Mallika Dixit
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Niharika Pattnaik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Ashish K Sharma
- Department of Urology, Lotus Hospital and Advanced Urology Centre, Raipur, India
| | - Yogesh R Barapatre
- Department of Urology, Lotus Hospital and Advanced Urology Centre, Raipur, India
| | - Manas Pradhan
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | | | - Debadarshi Rath
- Department of Urology, Uronephro Centre of Excellence, Bhubaneswar, India
| | - Sunil Jaiswal
- Department of Surgical Oncology, Apollo Hospital, Bhubaneswar, India
| | - Stithi Das
- Department of Radiation Oncology, Apollo Hospital, Bhubaneswar, India
| | | | - Sudhasmita Routa
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Manas R Baisakh
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Romila Tiwari
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Nakul Y Sampat
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Indranil Chakrabarti
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Kalyani, India
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, US
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
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3
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Challa B, Mohanty SK, Jha S, Sampat NY, Sardana R, Lobo A, Sharma S, Arora S, Rath D, Munjal G, Pattnaik N, Jain D, Jain E, Dewan A, Dixit M, Malik V, Shinde S, Balzer BL, Parwani A. SS18-SSX Expression in a Contemporary Cohort of Primary Renal Synovial Sarcoma: A Multi-Institutional Experience of Fourteen Patients. Int J Surg Pathol 2023; 31:1232-1243. [PMID: 36591871 DOI: 10.1177/10668969221143481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary renal synovial sarcoma is a rare aggressive mesenchymal neoplasm of the kidney that accounts for less than 1% of renal sarcomas. Herein, we describe the clinicopathologic and molecular findings of 14 renal synovial sarcoma patients in one of the largest case series to date and to our knowledge, the only renal synovial sarcoma series to use novel SS18-SSX IHC. Clinicopathologic, IHC, molecular, management, and follow-up data were reviewed and analyzed. Macroscopically, the tumors had either homogeneous, tan-white, and solid (n = 10), variegated and solid (n = 3), or variegated and solid-cystic (n = 1) cut surfaces. Spindle cell (n = 10), round cell (n = 3), and round to epithelioid morphologies (n = 1) were observed. SS18-SSX IHC was positive in all 14 tumors (diffuse, n = 10; multifocal, n = 2; focal, n = 2). All the tumors harbored SS18::SSX1/2 gene rearrangement. Metastases to the liver, brain, and lung (n = 1); liver and bone (n = 1); liver and diaphragm (n = 1) were identified. Adjuvant chemotherapy was administered in 11/12 patients. Follow-up was available for 10 patients (time period range: 5 to 24 months). Four patients died of disease, and six patients are alive with no recurrence or metastasis. As SS18-SSX IHC showed an excellent concordance with the FISH results, this may reliably be used in the IHC panel of spindle/round cell sarcomas of the kidney and as a molecular surrogate for renal synovial sarcoma, particularly in a resource-limited setting. Also, the tumors with focal SS18-SSX expression had lower break apart signals in the FISH assay (19% and 23% in two tumors with focal SS18-SSX IHC positivity).
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Affiliation(s)
- Bindu Challa
- Departments of Pathology and Laboratory Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sambit K Mohanty
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Shilpy Jha
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
| | - Nakul Y Sampat
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
| | - Ruhani Sardana
- Departments of Pathology and Laboratory Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anandi Lobo
- Departments of Pathology and Laboratory Medicine, Kapoor Center of Urology and Pathology, Raipur, India
| | - Shivani Sharma
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Samriti Arora
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Debadarshi Rath
- Departments of Pathology and Laboratory Medicine, Advanced Urology Maxport Hospital, Bhubaneswar, India
| | - Gauri Munjal
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Niharika Pattnaik
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
| | - Deepika Jain
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ekta Jain
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Aditi Dewan
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Mallika Dixit
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Vipra Malik
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Sayali Shinde
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Bonnie L Balzer
- Departments of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anil Parwani
- Departments of Pathology and Laboratory Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
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4
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Williamson SR, Hes O, Trpkov K, Aggarwal A, Satapathy A, Mishra S, Sharma S, Sangoi A, Cheng L, Akgul M, Idrees M, Levin A, Sadasivan S, San Miguel Fraile P, Rogala J, Comperat E, Berney DM, Bulimbasic S, McKenney JK, Jha S, Sampat NY, Mohanty SK. Low-grade oncocytic tumour of the kidney is characterised by genetic alterations of TSC1, TSC2, MTOR or PIK3CA and consistent GATA3 positivity. Histopathology 2023; 82:296-304. [PMID: 36208048 DOI: 10.1111/his.14816] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/11/2022] [Accepted: 10/06/2022] [Indexed: 12/13/2022]
Abstract
Low-grade oncocytic tumour (LOT) of the kidney has recently emerged as a potential novel tumour type. Despite similarity to oncocytoma or eosinophilic chromophobe renal cell carcinoma, it shows diffuse keratin 7 immunohistochemistry (IHC) and negative KIT (CD117), which differs from both. We aimed to identify the molecular characteristics of these tumours. Seventeen tumours (one male, 16 female, nine previously published) fitting the original description of this entity (solid eosinophilic cell morphology, often with areas of tumour cells loosely stretched in oedematous stroma, and the above IHC features) were analysed with a next-generation sequencing panel of 324 cancer-associated genes from formalin-fixed, paraffin-embedded tissue. All tumours harboured at least one alteration in either TSC1 (n = 7, 41%), TSC2 (n = 2, 12%), MTOR (n = 5, 29%) or PIK3CA (n = 4, 24%). Four tumours harboured a second alteration, including two NF2, one each in conjunction with MTOR and TSC2 alterations, one PTEN with TSC1 alteration and one tumour with both MTOR and TSC1 alterations. No other renal cancer-related or recurring gene alterations were identified. In addition to the previously described IHC findings, 16 of 16 were positive for GATA3. Eleven patients with follow-up had no metastases or recurrent tumours. Recurrent tuberous sclerosis/MTOR pathway gene alterations in LOT support its consideration as a distinct morphological, immunohistochemical and genetic entity. PIK3CA is another pathway member that may be altered in these tumours. Further study will be necessary to determine whether tumour behaviour or syndromic associations differ from those of oncocytoma and chromophobe carcinoma, warranting different clinical consideration.
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Affiliation(s)
- Sean R Williamson
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ondrej Hes
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Alberta Precision Labs and University of Calgary, Calgary, Alberta, Canada
| | | | | | - Sourav Mishra
- Advanced Medical Research Institute, Bhubaneswar, Odisha, India
| | | | - Ankur Sangoi
- Department of Pathology, El Camino Hospital, Mountain View, CA, USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mahmut Akgul
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Muhammad Idrees
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Albert Levin
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - Sudha Sadasivan
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | | | | | - Eva Comperat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris VI, Paris, France
| | - Daniel M Berney
- Department of Cellular Pathology, Bartshealth NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Jesse K McKenney
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shilpy Jha
- Advanced Medical Research Institute, Bhubaneswar, Odisha, India
| | - Nakul Y Sampat
- Advanced Medical Research Institute, Bhubaneswar, Odisha, India
| | - Sambit K Mohanty
- CORE Diagnostics, Gurgaon, Haryana, India.,Advanced Medical Research Institute, Bhubaneswar, Odisha, India
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5
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Jha S, Mohanty SK, Sampat NY, Naik S, Baisakh MR, Pattnaik N, Lobo A, Rauta S, Sharma S, Munjal G, Jain D, Arora S, Malik V, Jain E, Sahoo B, Bhardwaj M, Mishra SK, Jaiswal S, Barik LM, Balzer BL, Chakrabarti I, Parwani AV. Solitary Fibrous Tumor of the Adrenal Gland. Am J Clin Pathol 2022; 158:546-554. [PMID: 35993354 DOI: 10.1093/ajcp/aqac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that can arise at various anatomic locations. It is characterized by inv12(q13q13)-derived NAB2::STAT6 fusion, resulting in the nuclear expression of STAT6. Primary SFT of the adrenal gland is rare. We launched a multi-institutional collaboration to comprehend the overarching demographics, clinical and follow-up, macroscopic, microscopic, IHC, and FISH features of 9 patients with SFT of the adrenal gland. METHODS We added a series of 9 patients to the collection of adrenal SFTs where the clinicopathologic parameters, including clinical presentation, imaging, histopathology, IHC, molecular profiles, and management and follow-up data, were analyzed comprehensively. A modified 4-variable risk stratification model, including age, tumor size, and necrosis, was applied. RESULTS Our series consisted of 6 male and 3 female patients, ranging in age from 19 to 64 years (mean, 49.3 years). Abdominal pain (4) and fever with abdominal pain (1) were the presenting symptoms in 5 patients. In the remaining 4 patients, the tumors were detected by abdominal imaging for hypertension and diabetes. The size of the tumor ranged from 2 cm to 10.5 cm in maximum dimension. All tumors exhibited the morphology of a spindle cell SFT with a patternless architecture; 3 had a focal storiform arrangement. STAT6 positivity was observed in all tumors, and 7 were positive for CD34. Surgical resection was the primary modality of treatment. No adjuvant therapy was administered. Follow-up ranging from 7 months to 23 months was available for 7 patients. All were alive without disease recurrence or metastasis. Risk stratification placed 8 (88.9%) patients into a low-risk category and 1 into an intermediate-risk category. CONCLUSIONS This series is the largest of adrenal SFTs to date. These tumors of the adrenal gland are predominantly spindle cell neoplasms with indolent behavior, with a wide age distribution and a slight male preponderance. Combining our cohort with the previously published cases, the majority of tumors fall into the low-risk category for the propensity to develop metastases. Owing to the rarity and age distribution associated with these tumors, the differential diagnosis is wide and requires a systematic approach for ruling out key differential diagnoses aided by STAT6 IHC.
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Affiliation(s)
- Shilpy Jha
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Nakul Y Sampat
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Subhasini Naik
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Manas R Baisakh
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Apollo Hospital and Apollo Cancer Institute, Bhubaneswar, India
| | - Niharika Pattnaik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sudhasmita Rauta
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Gauri Munjal
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Deepika Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Samriti Arora
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Vipra Malik
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mohit Bhardwaj
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Saurav K Mishra
- Department of Medical Oncology, Apollo Cancer Institute, Bhubaneswar, India
| | - Sunil Jaiswal
- Department of Surgical Oncology, Apollo Cancer Institute, Bhubaneswar, India
| | - Lalit M Barik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Bonnie L Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA,USA
| | - Indranil Chakrabarti
- Department of Pathology and Laboratory Medicine, North Bengal Medical College, Siliguri, India
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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6
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Pattnaik N, Parmar R, Nayak B, Sampat NY, Jha S, Jena MR, Barik LM, Mishra SK, Munjal G, Chottaraji A, Mohanty SK. Meningeal Rosai-Dorfman Disease Presenting as an Intracranial Mass - Report of a Case with Review of the Literature. Int J Surg Pathol 2022; 31:478-484. [PMID: 35651311 DOI: 10.1177/10668969221102615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Meningeal Rosai-Dorfman disease, a type of sporadic Rosai-Dorfman disease, is a rare occurrence. A few cases are reported in the English literature with an adequate immunohistochemical workup. This entity clinically and radiologically mimics either a meningeal or a parenchymal neoplasm with meningeal extension, warranting a thorough histopathologic evaluation. A broad histologic differential necessitates a detailed immunohistochemical characterization to render a correct diagnosis that has significant therapeutic and prognostic implications. Herein, we report a case of isolated meningeal Rosai-Dorfman disease in a 50-years-old human immunodeficiency virus-positive male patient with an emphasis on the histopathology, immunoprofile, and differential diagnoses.
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Affiliation(s)
- Niharika Pattnaik
- Department of Pathology and Laboratory Medicine, 487305Advanced Medical Research Institute, Bhubaneswar, India
| | - Rajni Parmar
- Department of Pathology and laboratory Medicine, The Lal Pathology Laboratories, Delhi, India
| | - Biswaranjan Nayak
- Department of Neurosurgery, Advanced Medical Research Institute, Bhubaneswar, India
| | - Nakul Y Sampat
- Department of Pathology and Laboratory Medicine, 487305Advanced Medical Research Institute, Bhubaneswar, India
| | - Shilpy Jha
- Department of Pathology and Laboratory Medicine, 487305Advanced Medical Research Institute, Bhubaneswar, India
| | - Manas R Jena
- Department of Radiology, 410775Advanced Medical Research Institute, Bhubaneswar, India
| | - Lalit M Barik
- Department of Pathology and Laboratory Medicine, 487305Advanced Medical Research Institute, Bhubaneswar, India
| | - Sourav K Mishra
- Department of Medical Oncology, Advanced Medical Research Institute, Bhubaneswar, India
| | - Gauri Munjal
- Department of Pathology and Laboratory Medicine, 487305Advanced Medical Research Institute, Bhubaneswar, India
| | | | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, 487305Advanced Medical Research Institute, Bhubaneswar, India
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Sharma S, Lobo A, Sharma A, Sampat NY, Kumar M, Kajla R, Mohapatra SS, Mohanty SK. Primary extraskeletal myxoid chondrosarcoma of the breast: report of a case and literature review. Pathologica 2022; 114:228-237. [PMID: 35775709 PMCID: PMC9248243 DOI: 10.32074/1591-951x-303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Primary extraskeletal myxoid chondrosarcoma (pEMC) of the breast is rare and only a few cases have been reported to date. Herein, we report a case of primary EMC of the breast in a 45-year-old female. The patient presented with a left breast mass for 1 month. Mammogram revealed a fairly circumscribed mass with spicules of calcifications. The core biopsy and resection specimen showed a myxoid soft tissue neoplasm with histologic features of a myxoid chondrosarcoma. Necrosis, hemorrhage, and brisk mitotic activity were present. No malignant epithelial element was identified even after extensive sampling. The tumor cells exhibited immunoreactivity for vimentin, S100, neuron specific enolase, CD99, and synaptophysin, while the epithelial, myoepithelial, and mammary lineage-associated markers were negative. As up to 81% of EMC cases harbor t(9;22)(q22;q12), this results in a fusion of EWS RNA-binding protein 1 gene (EWSR1) at 22q12 to the nuclear receptor subfamily 4, group A, member 3 gene at 9q22. A rearrangement involving the EWSR1 locus was detected in our case. Whole body PET-CT did not reveal any other mass. A diagnosis of pEMC was rendered. The patient received six cycles of 5-Fluorouracil, Cyclophosphamide, and Adriamycin. The patient was in clinical and radiologic remission at the last follow-up (18 months post surgery). PET-CT and brain MRI were negative. In conclusion, surgical pathologists should include EMC in their differential while dealing with a myxoid soft tissue lesion of the breast, particularly in the core needle biopsies. An expeditious diagnosis of EMC of the breast would allow the surgeon to carry out conservative breast surgery instead of more radical approaches taken in cases of other primary malignant mammary neoplasms.
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Affiliation(s)
- Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, Odisha, India
| | - Anurag Sharma
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nakul Y Sampat
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, Odisha, India
| | - Mohit Kumar
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ramkrishan Kajla
- Department of Surgery, Matrachhya Medical Center, Bikaner, Rajasthan, India
| | - Satya S Mohapatra
- Department of Radiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, Odisha, India
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