Naohiro Makise1,2, Masaya Sekimizu3, Takashi Kubo4, Susumu Wakai1, Shun-Ichi Watanabe5, Tomoyasu Kato6, Takayuki Kinoshita7, Nobuyoshi Hiraoka1, Masashi Fukayama2, Akira Kawai8,9, Hitoshi Ichikawa3,4, Akihiko Yoshida1,9. 1. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan. 2. Department of Pathology, The University of Tokyo, Tokyo, Japan. 3. Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan. 4. Division of Translational Genomics, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Tokyo, Japan. 5. Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan. 6. Division of Gynecology, National Cancer Center Hospital, Tokyo, Japan. 7. Division of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan. 8. Department of Musculoskeleltal Oncology, National Cancer Center Hospital, Tokyo, Japan. 9. Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan.
Abstract
AIMS: Extraskeletal osteosarcoma (ESOS) is a sarcoma in the non-skeletal tissue that directly produces neoplastic osteoid or bone. De-differentiated liposarcoma (DDLPS) and malignant peripheral nerve sheath tumour (MPNST) are the two most common types of sarcoma that can harbour heterologous osteosarcomatous differentiation. We aimed to determine the potential relationship of ESOS to DDLPS and MPNST. METHODS AND RESULTS: We investigated MDM2 and H3K27me3 status in 19 cases of ESOS, two of which contained a low-grade component. The ESOS affected deep soft tissues (n = 10), superficial soft tissues (n = 3) and organs (n = 6). Among 10 deep soft-tissue ESOS, six showed MDM2 amplification, four of which also harboured CDK4 co-amplification. Both ESOS with a low-grade component showed co-amplification for MDM2 and CDK4. Among the six organ-based ESOS three giant cell-rich ESOS showed an H3K27me3 deficiency (one in primary and two in metastatic sites). Using targeted next generation sequencing, an H3K27me3-deficient ESOS showed EED homozygous deletion, while none of the three showed alterations in NF1, CDKN2A or SUZ12 genes. During median follow-up of 20 months, all six patients with MDM2-amplified ESOS lived for 3-103 months, while two of the three patients with H3K27me3-deficient ESOS died from this disease in 4 and 20 months, respectively. CONCLUSION: We demonstrate that ESOS may include at least two small subsets: an MDM2-amplified deep soft-tissue ESOS (which may be related to DDLPS) and an H3K27me3-deficient organ-based ESOS (which is probably unrelated to MPNST). Larger studies are required to validate the present observations and investigate the clinical implications of such subcategorisation.
AIMS: Extraskeletal osteosarcoma (ESOS) is a sarcoma in the non-skeletal tissue that directly produces neoplastic osteoid or bone. De-differentiated liposarcoma (DDLPS) and malignant peripheral nerve sheath tumour (MPNST) are the two most common types of sarcoma that can harbour heterologous osteosarcomatous differentiation. We aimed to determine the potential relationship of ESOS to DDLPS and MPNST. METHODS AND RESULTS: We investigated MDM2 and H3K27me3 status in 19 cases of ESOS, two of which contained a low-grade component. The ESOS affected deep soft tissues (n = 10), superficial soft tissues (n = 3) and organs (n = 6). Among 10 deep soft-tissue ESOS, six showed MDM2 amplification, four of which also harboured CDK4 co-amplification. Both ESOS with a low-grade component showed co-amplification for MDM2 and CDK4. Among the six organ-based ESOS three giant cell-rich ESOS showed an H3K27me3 deficiency (one in primary and two in metastatic sites). Using targeted next generation sequencing, an H3K27me3-deficient ESOS showed EED homozygous deletion, while none of the three showed alterations in NF1, CDKN2A or SUZ12 genes. During median follow-up of 20 months, all six patients with MDM2-amplified ESOS lived for 3-103 months, while two of the three patients with H3K27me3-deficient ESOS died from this disease in 4 and 20 months, respectively. CONCLUSION: We demonstrate that ESOS may include at least two small subsets: an MDM2-amplified deep soft-tissue ESOS (which may be related to DDLPS) and an H3K27me3-deficient organ-based ESOS (which is probably unrelated to MPNST). Larger studies are required to validate the present observations and investigate the clinical implications of such subcategorisation.
Authors: Maria Del Carmen Rodriguez Pena; Jennifer Gordetsky; Patricia T Greipp; Shi Wei; Guido Martignoni; George J Netto; Shuko Harada; Carlos N Prieto Granada Journal: Virchows Arch Date: 2020-05-15 Impact factor: 4.064