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Kournoutas I, Monga V, Davick J, Rieth J. Objective Responses in Metastatic Pleomorphic Rhabdomyosarcoma Treated with Combination of Doxorubicin and Pembrolizumab: A Case Series. Case Rep Oncol 2024; 17:344-351. [PMID: 38404403 PMCID: PMC10890802 DOI: 10.1159/000535959] [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: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction Pleomorphic rhabdomyosarcoma is a rare subtype of rhabdomyosarcoma, a soft tissue sarcoma with skeletal muscle differentiation. Although rhabdomyosarcoma is typically seen in the pediatric population, the pleomorphic variant most frequently presents in adulthood and is characteristically aggressive with no currently established treatment regimen in the setting of metastatic disease. There has been growing interest in the application of immune checkpoint inhibitors alongside conventional chemotherapeutic agents in the treatment of pleomorphic rhabdomyosarcoma. Case Presentation In the present case series, we report 2 patients with metastatic pleomorphic rhabdomyosarcoma treated with combination doxorubicin and pembrolizumab who had confirmed objective responses. Of note, these 2 patients had variable PD-L1 status - negative and low positive. Duration of treatment response was notable at 14 months and 9 months, respectively, with the first patient remaining on maintenance pembrolizumab therapy and the second patient subsequently achieving complete response with third-line trabectedin. Both patients are currently undergoing routine interval imaging with no evidence of disease at this time. Conclusion This report highlights and discusses the potential role of PD-1 blockade in the treatment of pleomorphic rhabdomyosarcoma and also discusses burgeoning immunological data that may explain the clinical responses seen in these 2 cases.
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Affiliation(s)
- Ioannis Kournoutas
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Varun Monga
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Jonathan Davick
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - John Rieth
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Beird HC, Wu CC, Nakazawa M, Ingram D, Daniele JR, Lazcano R, Little L, Davies C, Daw NC, Wani K, Wang WL, Song X, Gumbs C, Zhang J, Rubin B, Conley A, Flanagan AM, Lazar AJ, Futreal PA. Complete loss of TP53 and RB1 is associated with complex genome and low immune infiltrate in pleomorphic rhabdomyosarcoma. HGG Adv 2023; 4:100224. [PMID: 37593416 PMCID: PMC10428123 DOI: 10.1016/j.xhgg.2023.100224] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Rhabdomyosarcoma accounts for roughly 1% of adult sarcomas, with pleomorphic rhabdomyosarcoma (PRMS) as the most common subtype. Survival outcomes remain poor for patients with PRMS, and little is known about the molecular drivers of this disease. To better characterize PRMS, we performed a broad array of genomic and immunostaining analyses on 25 patient samples. In terms of gene expression and methylation, PRMS clustered more closely with other complex karyotype sarcomas than with pediatric alveolar and embryonal rhabdomyosarcoma. Immune infiltrate levels in PRMS were among the highest observed in multiple sarcoma types and contrasted with low levels in other rhabdomyosarcoma subtypes. Lower immune infiltrate was associated with complete loss of both TP53 and RB1. This comprehensive characterization of the genetic, epigenetic, and immune landscape of PRMS provides a roadmap for improved prognostications and therapeutic exploration.
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Affiliation(s)
- Hannah C. Beird
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chia-Chin Wu
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael Nakazawa
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Davis Ingram
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph R. Daniele
- TRACTION Platform, Division of Therapeutics Discovery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rossana Lazcano
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Latasha Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christopher Davies
- Research Department of Pathology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Najat C. Daw
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Khalida Wani
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei-Lien Wang
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xingzhi Song
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Brian Rubin
- Institute Chair, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Anthony Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adrienne M. Flanagan
- Research Department of Pathology, UCL Cancer Institute, London WC1E 6DD, UK
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP, UK
| | - Alexander J. Lazar
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - P. Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Li ZJ, Li CL, Wang W, Fu XY, Zhen YQ. Diagnosis and treatment of pleomorphic rhabdomyosarcoma of the uterus: a rare case report and review of the literature. J Int Med Res 2021; 49:3000605211014360. [PMID: 34034549 PMCID: PMC8161909 DOI: 10.1177/03000605211014360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 02/03/2023] Open
Abstract
Pleomorphic rhabdomyosarcomas of the uterus (PRMSu) is a rare malignant tumor of the female genital tract. Accurate diagnosis and effective treatment of PRMSu are important. We report an 81-year-old woman who was diagnosed with PRMSu. She had an extremely unusual presentation of secondary dyspnea because of an extremely large uterus (26.0 cm). Pelvic magnetic resonance imaging showed rare severe enlargement and intrauterine filling with tumor tissue, and she was initially diagnosed with uterine leiomyosarcoma. The patient underwent hysterectomy, as well as bilateral salpingo-oophorectomy and omentectomy, and was finally confirmed as having PRMSu by histopathology combined with immunohistochemistry. We performed a systematic review of the literature between 1982 and 2020 and focused on different treatment strategies and prognosis of PRMSu. A retrospective review of 28 cases was conducted and survival analysis was estimated by using the Kaplan–Meier method. We found that the accuracy of diagnosis of PRMSu completely depends on histopathology and immunohistochemistry because of no special clinical symptoms, no sensitive tumor markers, and no special imaging findings. Although there is no standardized approach for treating this rare disease, the treatment strategy of a surgical operation combined with adjuvant chemotherapy appears to be the best choice.
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Affiliation(s)
- Zi-Jun Li
- Department of Gynecology, ZheJiang QuHua Hospital, QuZhou, ZheJiang, China
| | - Cheng-Lie Li
- Department of Pathology, ZheJiang QuHua Hospital, QuZhou, ZheJiang, China
| | - Wei Wang
- Center of Clinical Imaging Diagnosis, ZheJiang QuHua Hospital, QuZhou, ZheJiang, China
| | - Xiao-Ying Fu
- Department of Gynecology, ZheJiang QuHua Hospital, QuZhou, ZheJiang, China
| | - Ya-Qin Zhen
- Center of Clinical Laboratory Diagnosis, ZheJiang QuHua Hospital, QuZhou, ZheJiang, China
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4
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Siregar KB, Azrah A. Pleomorphic rhabdomyosarcoma on the chest wall which infiltrated intercostal muscles: A case report. Int J Surg Case Rep 2020; 75:380-384. [PMID: 32987291 PMCID: PMC7522040 DOI: 10.1016/j.ijscr.2020.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/06/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) is the malignant tumor of skeletal muscles that origin from rhabdomyoblast. RMS is the most common soft tissue tumor in children, but this is a sporadic condition in adults and only 1% of any solid malignancies of an adult. The most prevalent subtype of RMS in an adult is a pleomorphic type. PRESENTATION OF CASE We reported a case of a 57 years old woman with swelling on the left chest with pain for three years. Physical examination revealed swelling on the left chest with solid consistency and immobile. The thorax CT-scan with IV contrast suspicious soft tissue tumor on the anteromedial of the left chest wall that stuck to the left lung. DISCUSSION Histopathological examination confirmed the pleomorphic subtype of rhabdomyosarcoma. The interdisciplinary idea was reported to be superior to a single therapeutic modality. The patient underwent an incisional biopsy. CONCLUSION This is a case of pleomorphic rhabdomyosarcoma diagnosed base on histopathology from an incisional biopsy, and IHC performed wide excision gave satisfactory results.
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Affiliation(s)
- Kamal Basri Siregar
- Oncology Surgery Department, Faculty of Medicine, Universitas Sumatera Utara, Universitas Sumatera Utara Hospital, Jl. Dr Mansyur No. 66, Medan, 20154, Indonesia.
| | - Arjumardi Azrah
- General Surgery Department, Faculty of Medicine, Universitas Sumatera Utara, Universitas Sumatera Utara Hospital, Jl. Dr Mansyur No. 66, Medan, 20154, Indonesia
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5
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Chen X, Zou C, Yang C, Gao L, Bi LK, Xie DD, Yu DX. Pleomorphic rhabdomyosarcoma of the spermatic cord and a secondary hydrocele testis: A case report. World J Clin Cases 2020; 8:2641-2646. [PMID: 32607344 PMCID: PMC7322420 DOI: 10.12998/wjcc.v8.i12.2641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pleomorphic rhabdomyosarcoma (RMS) of the spermatic cord is a group of rare neoplasms, and a secondary hydrocele testis occasionally occurs. The misdiagnosis of paratesticular mass may lead to a therapeutic delay.
CASE SUMMARY A 79-year-old man presented to our clinic complaining of a 1-mo history of painless scrotal swelling. Physical examination revealed approximately a 15 cm × 10 cm × 5 cm inguinal mass with limited mobility. Contrast-enhanced magnetic resonance imaging showed a hydrocele testis, several enlarged inguinal lymph nodes, and a heterogeneously enhanced lesion with a relatively well-defined margin in the left inguinal region. Due to the imaging findings, he was diagnosed with pleomorphic RMS and received a wide resection of the mass, an inguinal incision with a high section of the left spermatic cord, and a left radical orchiectomy. He experienced local relapse 1 mo postoperatively and received radiotherapy and anlotinib hydrochloride-based immunotherapy as adjuvant therapy. The patient died 3 mo after the surgery.
CONCLUSION The optimal interventions for advanced-stage pleomorphic RMS patients should be investigated by more preclinical studies and clinical trials. Physicians need to be aware of the occurrence of pleomorphic RMS in unusual locations, especially when accompanied by a hydrocele testis.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Ci Zou
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Chao Yang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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6
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Taza F, Kanwal A, Zulty M, Mustafa S. High-grade pleomorphic rhabdomyosarcoma in a 60-year-old male: a case report and review of the literature. J Community Hosp Intern Med Perspect 2020; 10:287-289. [PMID: 32850081 PMCID: PMC7426990 DOI: 10.1080/20009666.2020.1766820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/03/2022] Open
Abstract
Rhabdomyosarcoma is an aggressive malignant soft-tissue sarcoma that develop from undifferentiated mesenchymal cells. Less than 1% of all adult solid malignant cancers are sarcomas, and RMSs represent less than 2–5% of adult sarcomas. RMS is divided into three main subtypes: Embryonal, alveolar and pleomorphic RMS (PRMS). Most common subtype in adults is PRMS. Most common primary sites are extremities, trunk wall, and genitourinary organs. Metastasis are often found at diagnosis. 5-year overall survival rates were reported in the Surveillance, Epidemiology, and End Results database (SEER) to be 63% for pediatric patients and 27% for adults. Given the rarity of the adult PRMS, variation in its clinical presentation, characteristics of the tumor itself and the prognosis; there are very limited data available to guide the management of adults with PRMS. Herein we present a case report of pleomorphic rhabdomyosarcoma of the right thigh in a 60-year-old male who achieved a long-term survival (30 months) which was accomplished by multimodality treatment including surgery, radiotherapy, and chemotherapy.
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Affiliation(s)
- Fadi Taza
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Arjun Kanwal
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Mary Zulty
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Sadaf Mustafa
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
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7
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Feroce F, Cantile M, Aquino G, Collina F, Scognamiglio G, Castaldo L, Perdonà S, Botti G, De Chiara A. Molecular characterization of a bladder pleomorphic rhabdomyosarcoma in an adult patient. Pathol Res Pract 2020; 216:153033. [PMID: 32703497 DOI: 10.1016/j.prp.2020.153033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
Pleomorphic rhabdomyosarcoma (PRMS) is a rare but highly aggressive soft tissue tumor, accounting for 3% of soft tissue sarcomas. PRMS is the most frequent subtype of RMS in adulthood and it is mainly located in the large muscles of the extremities, particularly the lower limbs and the trunk, more rarely in other locations especially in the bladder. At our knowledge, only six cases of adult pleomorphic rhabdomyosarcoma of the bladder have been reported in the literature. In this study, we report a case of PRMS of bladder with a very poor prognosis. In fact, the patient died a month after surgery. The tumor was characterized by poorly differentiated, medium-sized sometimes rhabdoid cells, mixed with large-sized and pleomorphic elements with evident anisonucleosis, and with large areas of necrosis. We used an extensive immunohistochemical panel to exclude other tumors much more frequently reported at this site. The positivity for myogenic markers such as actin, desmin, myogenin and MyoD1 allowed the correct diagnosis. Furthermore, since preliminary studies highlighted a series of specific molecular alterations in PMRS cell lines, we analyzed a panel of specific mutations and gene rearrangements by RT-PCR and FISH methods. We showed a copy gains of CCND1 and MALT genes in our samples, suggesting an accurate molecular characterization of PRMS to establish a better management of patients and new therapeutic opportunities.
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Affiliation(s)
- Florinda Feroce
- Pathology Unit, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy
| | - Monica Cantile
- Pathology Unit, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy.
| | - Gabriella Aquino
- Pathology Unit, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy
| | - Francesca Collina
- Pathology Unit, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto nazionale tumori-irccs-fondazione g. Pascale, Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto nazionale tumori-irccs-fondazione g. Pascale, Naples, Italy
| | - Gerardo Botti
- Scientific Direction, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy
| | - Annarosaria De Chiara
- Pathology Unit, Istituto nazionale tumori-irccs-fondazione g. pascale, Naples, Italy
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8
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Okazaki M, Tajima H, Ohbatake Y, Shinbashi H, Nakanuma S, Makino I, Ninomiya I, Fushida S, Ohtsubo K, Ohta T. Pleomorphic rhabdomyosarcoma of the liver in an adult: a rare case report. BMC Surg 2020; 20:81. [PMID: 32316960 PMCID: PMC7171846 DOI: 10.1186/s12893-020-00742-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/26/2020] [Accepted: 04/06/2020] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Rhabdomyosarcoma (RMS), a malignant neoplasm that normally differentiates to form striated muscle, is the most common type of childhood soft tissue sarcoma. However, it infrequently occurs in adults and is uncommon in the liver. We herein report a case of RMS of the liver in an adult. CASE PRESENTATION A 73-year-old woman was admitted to our institution for investigation of a hepatic mass. She had been followed for primary biliary cirrhosis for the past 20 years. A contrast-enhanced computed tomography scan of the abdomen showed a 12- × 10-cm heterogeneous low-density mass lesion containing cystic and solid components. A percutaneous liver biopsy was performed, and poorly differentiated cancer containing an RMS cell-like component was observed. The patient was diagnosed with RMS of the liver, and open surgery with right hepatic lobectomy was performed. Histopathological examination confirmed a diagnosis of pleomorphic RMS of the liver. The patient died of rapid progression of the tumor 6 months after the operation. CONCLUSIONS The tumor site in the present case is rare. The details of this case add to the current evidence base regarding establishment of the standard diagnosis and treatment of this rare condition. We recommend consideration of RMS as a differential diagnosis for hepatic tumors.
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Affiliation(s)
- Mitsuyoshi Okazaki
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Hidehiro Tajima
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshinao Ohbatake
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Shinbashi
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinichi Nakanuma
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Isamu Makino
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Itasu Ninomiya
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Sachio Fushida
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology Cancer Research Institute, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tetsuo Ohta
- Division of Cancer Medicine, Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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9
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Rekhi B, Gupta C, Chinnaswamy G, Qureshi S, Vora T, Khanna N, Laskar S. Clinicopathologic features of 300 rhabdomyosarcomas with emphasis upon differential expression of skeletal muscle specific markers in the various subtypes: A single institutional experience. Ann Diagn Pathol 2018; 36:50-60. [PMID: 30098515 DOI: 10.1016/j.anndiagpath.2018.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 05/15/2018] [Revised: 07/07/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
The present study was aimed at evaluating clinicopathologic and immunohistochemical (IHC) features of 300 rhabdomyosarcomas (RMSs), including differential IHC expression and prognostic value of myogenin and MyoD1 across various subtypes of RMSs. IHC expression of myogenin and MyoD1 was graded on the basis of percentage of tumor cells displaying positive intranuclear immunostaining i.e. grade 1 (1-25%); grade 2 (26-50%); grade 3 (51-76%) and grade 4 (76-100%).Clinical follow-up was available in 238 (79.3%) patients. Various clinicopathologic parameters were correlated with 3-year disease free survival (DFS) and overall survival (OS). There were 140 cases (46.7%) of alveolar RMS (ARMS), 90 of embryonal RMS (ERMS) (30%), 61 (20.3%) of spindle cell/sclerosing RMS and 9 cases (3%) of pleomorphic RMS. Most cases, barring pleomorphic RMSs, occurred in the first two decades (228 cases) (76%), frequently in males, in the head and neck region (126) (42%). By immunohistochemistry, desmin was positive in 292/299 (97.6%) tumors; myogenin in 238/267 (89.1%) and MyoD1 in 192/266 (72.2%) tumors. High myogenin expression (in ≥51% positive tumor cells) was significantly associated with ARMSs (95/121, 78.5%), as compared to other subtypes (48/117, 41%) (p value < 0.001). High MyoD1 expression (≥51% tumor cells) was seen in more cases of pure sclerosing, combined with spindle cell/sclerosing RMSs (10/10, 100%), as compared to the other subtypes (91/141, 67.4%) (p = 0.032). There was no significant difference between high myogenin expression and clinical outcomes. Patients without metastasis and harbouring tumors, measuring ≤5 cm showed a significant increase in OS, with p values = 0.01 and <0.001, respectively. ARMS was the most frequent subtype. There was a significant association between high myogenin expression and ARMSs and high MyoD1 expression and spindle cell/sclerosing RMSs. High myogenin expression did not correlate with clinical outcomes. Patients with smaller sized tumors and without metastasis had significantly better clinical outcomes.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Maharashtra, Mumbai, India.
| | - Chhavi Gupta
- Department of Surgical Pathology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Girish Chinnaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Sajid Qureshi
- Department of Surgical Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Tushar Vora
- Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Maharashtra, Mumbai, India
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10
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Bressner JA, McCarthy EF, Fayad LM, Morris CD. Primary rhabdomyosarcoma of the distal femoral diaphysis: a case report and review of the literature. Skeletal Radiol 2016; 45:1391-5. [PMID: 27412560 DOI: 10.1007/s00256-016-2430-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 02/02/2023]
Abstract
Primary rhabdomyosarcoma of the bone is an extremely rare condition with few examples reported in the literature. We present the case of a 34-year-old male who presented with a lesion in the distal femur with initial imaging features consistent with Ewing sarcoma. Histologically, the lesion consisted of atypical pleomorphic polygonal rhabdomyoblasts demonstrating focal desmin and myogenin expression. A diagnosis of pleomorphic rhabdomyosarcoma was rendered. Despite systemic treatment and surgery, this patient experienced a rapidly progressive disease course. We believe this is only the second report in the orthopedic literature of a case of primary pleomorphic rhabdomyosarcoma of the bone. The key imaging, pathologic, and clinical findings are discussed.
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11
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Ozaslan E, Berk V, Baldane S, Eker B, Bozkurt O, Senol S, Duran AO, Cubukcu G, Karaca H, Ozkan M. Primary Pleomorphic Rhabdomyosarcoma of Thyroid Gland in an Adult Patient: A Case Report. Eurasian J Med 2016; 48:69-72. [PMID: 27026769 DOI: 10.5152/eurasianjmed.2015.96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/22/2022] Open
Abstract
Thyroid sarcoma is a very rare entity, accounting for less than 1% of all malignant thyroid tumours. Rhabdomyosarcoma (RMS) is a sarcoma subtype, which is more common in children and adolescents. In this case, a 68-year old man, presented with hoarseness and diagnosed with pleomorphic RMS, was explored. No study of primary thyroid pure RMS has been reported in the literature, with the exception of the case reports of differentiated RMS.
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Affiliation(s)
- Ersin Ozaslan
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Veli Berk
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Suleyman Baldane
- Department of Endocrinology, Selçuk University School of Medicine, Konya, Turkey
| | - Baki Eker
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Oktay Bozkurt
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Serkan Senol
- Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ayse Ocak Duran
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Gulsah Cubukcu
- Department of Pathology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Halit Karaca
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Metin Ozkan
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
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12
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Noujaim J, Thway K, Jones RL, Miah A, Khabra K, Langer R, Kasper B, Judson I, Benson C, Kollàr A. Adult Pleomorphic Rhabdomyosarcoma: A Multicentre Retrospective Study. Anticancer Res 2015; 35:6213-6217. [PMID: 26504053] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Pleomorphic rhabdomyosarcoma (RMS) is a rare sub-type of RMS. Optimal treatment remains undefined. PATIENTS AND METHODS Between 1995 and 2014, 45 patients were diagnosed and treated in three tertiary sarcoma Centers (United Kingdom, Switzerland and Germany). Treatment characteristics and outcomes were analyzed. RESULTS The median age at diagnosis was 71.5 years (range=28.4-92.8 years). Median survival for those with localised (n=32, 71.1%) and metastatic disease (n=13, 28.9%) were 12.8 months (95% confidence interval=8.2-34.4) and 7.1 months (95% confidence interval=3.8-11.3) respectively. The relapse rate was 53.8% (four local and 10 distant relapses). In total, 14 (31.1%) patients received first line palliative chemotherapy including multi-agent paediatric chemotherapy schedules (n=3), ifosfamide-doxorubicin (n=4) and single-agent doxorubicin (n=7). Response to chemotherapy was poor (one partial remission with vincristine-actinomycin D-cyclophosphamide and six cases with stable disease). Median progression-free survival was 2.3 (range=1.2-7.3) months. CONCLUSION Pleomorphic RMS is an aggressive neoplasm mainly affecting older patients, associated with a high relapse rate, a poor and short-lived response to standard chemotherapy and an overall poor prognosis for both localised and metastatic disease.
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Affiliation(s)
| | - Khin Thway
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, U.K
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, U.K
| | - Aisha Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, U.K
| | - Komel Khabra
- Research Data Management and Statistics Unit, Royal Marsden NHS Foundation Trust, London, U.K
| | - Rupert Langer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumour Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Ian Judson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, U.K
| | | | - Attila Kollàr
- Department of Medical Oncology, University Hospital Bern, Sarcoma Center Inselspital, Bern, Switzerland
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13
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Pittore B, Fancello G, Cossu Rocca P, Ledda GP, Tore G. Rhabdomyosarcoma: a rare laryngeal neoplastic entity. Acta Otorhinolaryngol Ital 2010; 30:52-57. [PMID: 20559474 PMCID: PMC2881606] [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] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 04/04/2009] [Indexed: 05/29/2023]
Abstract
A case of pleomorphic rhabdomyosarcoma of the larynx is presented, which is extremely rare in a laryngeal site. The symptomatology and macroscopic aspect of the neoplasm can simulate the presence of other neoplastic variants of the larynx, and, for this reason, histological examination must be associated with immunohistochemistry for correct diagnosis and treatment.
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Affiliation(s)
- B Pittore
- Ear, Nose and Throat Department, Santissima Trinità Hospital, ASL 8 Cagliari, via Is Mirrionis 92, Cagliari,Italy.
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