Background
Case presentation
Antigen | Clone | Dilution | Manufacturer |
---|---|---|---|
Vimentin | MX034 | 1:200 | Fuzhou MXB Biotechnology Co,Ltd. China |
EMA | GP1.4 | 1:100 | Fuzhou MXB Biotechnology Co,Ltd. China |
CK-pan | polyclonal | 1:200 | Fuzhou MXB Biotechnology Co,Ltd. China |
CAM5.2 | CAM5.2 | 1:100 | Fuzhou MXB Biotechnology Co,Ltd. China |
CD31 | JC/70A | 1:100 | Fuzhou MXB Biotechnology Co,Ltd. China |
CD34 | QBEnd/10 | 1:100 | Fuzhou MXB Biotechnology Co,Ltd. China |
SMA | 1A4 | 1:200 | Fuzhou MXB Biotechnology Co,Ltd. China |
Calponin | MX023 | 1:300 | Fuzhou MXB Biotechnology Co,Ltd. China |
TTF-1 | 8G7G3/1 | 1:200 | Fuzhou MXB Biotechnology Co,Ltd. China |
S-100 | polyclonal | 1:200 | Fuzhou MXB Biotechnology Co,Ltd. China |
Desmin | D33 | 1:200 | Guangzhou Onco Care Biotechnology Co,Ltd. China |
ALK | MX064 | 1:200 | Guangzhou Onco Care Biotechnology Co,Ltd. China |
Discussion
Case No. (Ref. No.) | Age | sex | EBC (+/−) | Size (cm) | Pathological features | IHC | Molecular genetics | Treatment | Follow-up (months) |
---|---|---|---|---|---|---|---|---|---|
1(3) | 27 | F | EBC+ | 4 | Ill-defined nodules of myxoid stroma, interweaving cords of small uniform, round or slightly elongated cells with eosinophilic cytoplasm, occasional mitoses. | Vimentin+, CK-, S100-, desmin-, SMA-, CD34-. | ND | Surgery | NEOD after 36 |
2(3) | 43 | F | EBC+ | 13 | Ill-defined nodules of myxoid stroma, interweaving cords of small uniform, round or slightly elongated cells with eosinophilic cytoplasm, occasional mitoses. | Vimentin+, CK-, S100-, desmin-, SMA-, CD34-. | ND | Surgery | NEOD after 6 |
3(2) | 27 | F | EBC+ | 4 | Well circumscribed, lobulated, reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed no or minimal atypia. | CK-, S100-, desmin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 180 |
4(2) | 33 | F | EBC+ | 3.5 | Lobulated, reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed mild to moderate atypia. | CK-, S100-, desmin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 144 |
5(2) | 45 | F | EBC+ | 1.5 | Circumscribed, lobulated, cellular sheets or patternless, tumor cells showed mild to moderate atypia. | S100 focal+, CK-, desmin-, p63-. | Negative | Surgery | NEOD after 12 |
6(2) | 36 | F | NR | NR | Circumscribed with fibrous pseudocapsule. Reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed minimal atypia. | CK-, EMA-, TTF1-, S100-, desmin-. | Negative | Surgery | DOD with brain metastases a few months after diagnosis |
7(2) | 32 | F | EBC+ | NR | Lobulated. Reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed moderate atypia. | CK-, EMA-,S100-, desmin-. | EWSR1-CREB1 fusion | Surgery | NR |
8(2) | 28 | M | EBC+ | 2.8 | Infiltrative and lobulated, cellular sheets or patternless, tumor cells showed mild to moderate atypia, | EMA weak+, CK-, TTF1-, S100-, HMB45-, melan A-, desmin-. | EWSR1-CREB1 fusion | Surgery | Left renal metastasis, alive and well after 3 years. |
9(2) | 67 | M | EBC+ | 2.8 | Well circumscribed and lobulated, reticular network with delicate lacelike strands and cords of cells within a prominent myxoid stroma., tumor cells showed minimal atypia. | EMA weak+, CK-, TTF-1-, S100-, desmin-. | EWSR1-CREB1 fusion | Surgery | NR |
10(2) | 68 | F | EBC+ | 2.0 | Well circumscribed and lobulated, reticular network with delicate lacelike strands and cords of cells within a prominent myxoid stroma, tumor cells showed moderate to marked atypia. | EMA weak+, CK-, p63-, TTF-1-, S100-, desmin-. | Negative | Surgery | NR |
11(2) | 63 | F | EBC+ | NR | Lobulated, cellular sheets or patternless, tunor cells showed mild to minimal atypia. | EMA weak +, CK-, TTF-1-, S100-, HMB45-, melan A-, desmin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 48 |
12(2) | 51 | M | NR | 2.0 | Well circumscribed and lobulated, reticular network with delicate lacelike strands and cords of cells within a prominent myxoid stroma, tumor cells showed mild to moderate atypia. | NR | EWSR1-CREB1 fusion | Surgery | NR |
13(5) | 31 | M | EBC+ | 2.7 | Well circumscribed, reticular cords of oval, short spindle or polygonal cells with mild atypia, rare mitotic figures, an abundant myxoid stroma, scattered lymphoplasmacytic infiltrates. | Vimentin+, EMA focal+, CK-, TTF-1-, napsin A-, S-100-, CD34-, desmin-, SMA-, CD10-, p63-, calponin- caldesmon-, c-kit-, HMB-45-, synaptophysin-, GFAP- | EWSR1-CREB1 fusion | Surgery | NEOD after 68 |
14(6) | 66 | F | EBC+ | 4 | Polygonal to spindled cells, reticular network with delicate lacelike strands and cords of cells within a prominent myxoid stroma, tumor cells showed mild atypia. | EMA focal+, CK-, p63-, S100-, desmin-. | EWSR1-CREB1 fusion | Surgery | NR |
15(6) | 28 | M | NR | 8.5 | Lobulated, biphasic, ~ 40% composed of myxoid pools, exuberant fibroinflammatory reaction with confluent plasma cells, tumor cells showed moderate atypia. | Desmin+, EMA focal+, CK-, p63-. S100-. | Negative | Surgery | NR |
16(6) | 28 | M | EBC+ | 6 | Infiltrative, focal necrosis and inflammation, tumor cells showed severe atypia. | EMA focal+, CK-, p63-, S100-. | EWSR1 rearrangement,. but not CREB1 | Surgery | NR |
17(7) | 26 | M | EBC+ | 9 | Multinodular, reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed mild to moderate atypia. | Vimentin+, EMA focal+, CD99 focal weak+, SMA-, desmin-, caldesmon-H-, calponin-, S100-, CK-, CD31-, CD34-, p63-, CD56-, synaptophysin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 19 |
18(7) | 49 | F | EBC- | 4 | Multinodular, reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed mild to moderate atypia. | Vimentin+, EMA focal+, CD99 focal weak+, SMA focal+, desmin-, caldesmon-H, calponin-, S100-, CK-, CD31-, CD34-, p63-, CD56-, synaptophysin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 117 |
19(7) | 54 | F | EBC+ | 4.5 | Multinodular, reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed moderate atypia. | Vimentin+, EMA focal+, CD99 focal+, SMA-, desmin-, caldesmon-H-, calponin-, S100-, CK-, CD31-, CD34-, p63-, CD56-, synaptophysin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 152 |
20(7) | 65 | M | EBC+ | 13 | Multinodular, reticular network with delicate lacelike strands and cords of cells within prominent myxoid stroma, tumor cells showed mild atypia. | Vimentin+, EMA focal+, CD99 focal+, SMA-, desmin-, caldesmon-H-, calponin-, S100-, CK-, CD31-, CD34-, p63-, CD56-, synaptophysin-. | EWSR1-CREB1 fusion | Surgery | Metastasis to contralateral lung, NEOD 72 months after removal of metastasis. |
21(8) | 29 | F | EBC- | 3 | Well circumscribed, short spindle, ovoid or stellate cells in reticular network, myxoid stroma, lymphoplasmacytic infiltration, tumor cells showed mild atypia. | Vimentin+, EMA+. SMA-, SMMHC-, calretinin-, TTF-1-, CK-, p63-, S-100-, CD34-, CD56-. | EWSR1-CREB1 fusion | Surgery | NEOD after 17 |
22(4) | 80 | F | EBC+ | NR | Multinodular, spindle cells arranged in reticular pattern within prominent myxoid stroma, tumor cells showed moderately atypia | Vimentin+, EMA focal+. CK-, S100-, HMB45-, CD31-, CD34-, SMA-, caldesmon-H-, desmin-, GFAP-. | EWSR1-CREB1 fusion | Surgery | NEOD after 36. |
23(9) | 32 | F | NR | 3.5 | Well-delineated lobulated, anastomosing cords and small nests of epithelioid cells admixed with stellate cells in chondromyxoid matrix. | Vimentin+, CD68 weak+, CD163 weak+, synaptophysin weak+. CK-, EMA-, calponin-, GFAP-, SMA-, desmin-, caldesmon-H-, S-100-, HMB-45-, CD34-, CD31-, chromogranin-. | EWSR1-CREB1 fusion | Surgery | NEOD after 96. |
24(10) | 21 | F | PA/EBC- | NR | Polypoid tumor, trabecular networks, rare solid areas, tumor cells showed oval nuclei and eosinophilic cytoplasm, | CK weak+, SMA+, INI1-, EMA-, S100-, desmin-, ERG-, MDM2-, CDK4-. | EWSR1-CREB1 fusion | Surgery | NEOD after 38 |
25(11) | 48 | M | NR | 14 | Bland looking medium-sized oval to round epithelioid cells arranged in prominent reticular and microcystic lace-like chordoid pattern in highly myxoid stroma. | Vimentin+, CD10 focal+、EMA focal+, CK-, TTF-1-, ERG-, CD31-, p63-, desmin-, SMA-, S100-, CD34-, CD30- , MUC4-, TLE1-, STAT6-. | Negative | Surgery | NEOD after 23 |
26 (our case) | 45 | F | EBC- | 2.1 | Well circumscribed, multinodular, reticular network of delicate lace-like cellular strands and cords in abundant myxoid stroma, chondrocyte or physaliferous-like tumor cells with mild atypia. | Vimentin+, EMA+, CK-, TTF-1-, CAM5.2-, S-100-, calponin-, SMA-, desmin-, ALK-, CD31-, CD34-. | EWSR1-CREB1 fusion | Surgery | NEOD after 38 |
Tumors | Pathological features | IHC | Molecular genetics | Differentiating features from PPMS |
---|---|---|---|---|
Primary pulmonary myxoid sarcoma (PPMS) | Well-circumscribed, lobulated, reticular network of delicate lace-like cellular strands and cords in abundant myxoid stroma, tumor cells are stellate, polygonal with also chondrocyte-like or physaliferous-like tumor cells first reported in our case, prominent lymphoplasmacytic infiltrates within and at periphery of tumor. | Vimentin+, EMA+, CK--, TTF-1-, S-100-, calponin-, SMA-, desmin-, ALK-, CD31-, CD34-. | EWSR1-CREB1 fusion | NA |
Extraskeletal myxoid chondrosarcoma (EMC) | Well-circumscribed, multinodular, tumor lobules separated by fibrous septae, umor cells epithelioid to spindled arranged in cords, strands, or clusters embedded in abundant myxoid stroma. | Vimentin+, S-100+, rarely EMA+, keratins+. | ,EWSR1-NR4A3, TFG-NR4A3, HSPA8-NR4A3, TCF12-NR4A3, FUS-NR4A3 or TAF15-NR4A3 gene fusion | S-100+, different molecular genetics. Rare as primary in lungs, may present as lung metastasis. |
Angiomatoid fibrous histiocytoma (AFH) | Sheets and islands of spindle to epithelioid cells with bland ovoid vesicular nuclei and abundant eosinophilic cytoplasm within loose myxoid stroma. | ALK+, desmin+. | EWSR1-ATF1, FUS-ATF1 gene fusion | No lobular or reticular architecture, no chondrocyte-like or physaliferous-like cells, ALK+ and desmin+, with different molecular genetics in AFH. |
Myoepithelial tumors (MT) | Well-circumscribed, solid sheets, nested or cord-like growth pattern, hyalinized or myxoid stroma, moderate to severe nuclear pleomorphism. | Cytokeratins+, EMA+, S100+, calponin+, SMA+, p63+, GFAP+. | EWSR1-FUS, EWSR1-PBX1, EWSR1-ZNF444, EWSR1-POU5F1 gene fusions | No reticular pattern, no chondrocyte-like or physaliferous-like cells, different 1HC and molecular genetics in MT. |
Pulmonary microcystic fibromyxoma (PMF) | Well-circumscribed, bland spindled to stellate cells widely spaced within prominent fibromyxoid stroma with prominent cystic change. | Vimentin+, CD34-, CD31-, HMB45-, SMA-, desmin-, S-100-, ALK-, CKpan-, EMA-, calretinin-, TTF1- | none | Prominent cystic pattern, much less cellular, no chondrocyte-like or physaliferous-like cells, no diagnostic molecular genetic change and not endobronchially located in PMF. |
Inflammatory myofibroblastic tumor (IMT) | Areas of myxoid stroma with prominent vessels or hyalinized collagenous stroma, and contain a prominent infltrate of plasma cells and lymphocytes. | SMA+, desmin+, ALK+, rarely keratins+ | RANBP2-ALK, RRBP1-ALK, ETV6-NTRK3 gene fusions | No reticular pattern, prominent inflammatory component, no chondrocyte-like or physaliferous-like cells, SMA+, ALK+ with different molecular genetics in IMT. |
Low grade myxoid liposarcoma (LGML) | Large well-circumscribed, monotonous small ovoid cells with fine chromatin, inconspicuous nucleoli, and scant cytoplasm., many characteristic lipoblasts., prominent plexiform vasculature, myxoid background with areas of mucin pooling, imparting a “pulmonary edema-like” pattern. | S-100+, rarely MDM2+ and CDK4+ | DDIT3-FUS and DDIT3-EWSR1 gene fusions | Characteristic prominent plexiform vasculature, “pulmonary edema-like” pattern, S-100+, different molecular genetics in LGML. Lung is rare site for primary LGML. |