Primary alveolar soft part sarcoma of bone

AIMS: Alveolar soft part sarcoma is a distinct, rare soft tissue tumour occurring primarily within the skeletal muscles or musculofascial planes in young adults. Primary involvement of bone is extremely rare. We report on six patients with alveolar soft part sarcoma occurring primarily in bone. METHODS AND RESULTS: Thorough clinical and radiographic examinations were done to rule out any other primary site. The patients were four women and two men aged 17-35 years (mean, 24.5 years). The primary site of the tumour was the femur in three patients, the ilium in one and the fibula in two. In one of the patients with fibular involvement, the tibia was also involved by direct extension. Of the long bone lesions, three were centred in the metaphysis and one in the diaphysis. Radiographically, all of the lesions demonstrated an osteolytic pattern of bone destruction with ill-defined margins and a wide zone of transition between the lesion and adjacent normal bone. Microscopically, all tumours showed the typical histological pattern of alveolar soft part sarcoma. Diastase-resistant, periodic acid-Schiff-positive crystalline structures were identified within the cytoplasm and confirmed ultrastructurally. Immunohistochemically, a keratin stain was negative in all cases; there was positive staining for MyoD1 in the cytoplasm but not the nuclei. Distant metastasis developed in four patients; one died. CONCLUSION: Alveolar soft part sarcoma arising in bone is extraordinarily rare but should be considered in the differential diagnosis of metastatic hypernephroma in a young patient.     

Primary alveolar soft part sarcoma of the lung

Alveolar soft part sarcoma (ASPS) is a rare epithelial-like soft tissue sarcoma. The two main sites of its occurrence are the lower extremities in adults and the head and neck in children. Primary pulmonary involvement of this sarcoma, without evidence of soft tissue tumor elsewhere, is very exceptional. We present a case of primary ASPS of the lung in a 42-yr-old woman. A computed tomographic scan of the thorax demonstrated a well-circumscribed, solid tumor located in the right upper lobe. The mass was resected by right upper lobectomy. After 5 months, three metastatic lesions, involving lumbar vertebrae and occipital scalp, were found. Histologically, the tumor consisted of alveolar nests of large polygonal tumor cells, the cytoplasm of which frequently revealed periodic acid-Schiff-positive, diastase-resistant intracytoplasmic rod-like structures. On immunohistochemical staining, the tumor cells were positive only for vimentin and alpha-smooth muscle actin. Ultrastructural study using electron microscopy revealed characteristic electron-dense, rhomboid intracytoplasmic crystals.     

Retroperitoneal sarcoma with features suggestive of alveolar soft part sarcoma.

A 72-year-old man presented with a 15 x 12 x 5 cm cystic and necrotic tumor involving the superior region of the stomach and the retroperitoneum down to the transverse colon and extending laterally from the left lobe of the liver to the spleen without involving either organ. Light microscopy showed the tumor cells to be arranged in an organoid pattern. Immunocytochemistry showed a strong reaction for desmin and vimentin. Electron microscopy demonstrated features suggestive of an alveolar soft part sarcoma.     

Cytologic features of alveolar soft part sarcoma: report of three cases

Alveolar soft part sarcoma (ASPS) is a rare, high-grade, epithelial-like sarcoma that shows characteristic histopathologic findings. Although a chromosomal anomaly that seems specific has been recently described, its diagnosis is based on histologic and ultrastructural features. The tumor shows no specific immunohistologic findings. Cytologic features of three cases of ASPS are presented. Preoperative fine-needle aspiration (FNA) of the primary soft tissue tumor was performed in two cases. In another two, mediastinal and pulmonary and subcutaneous metastatic lesions were aspirated. In all cases the cytologic image was identical with numerous, dissociated, large neoplastic cells with round-to-plasmocytoid morphology. Cytoplasmic fragility and granularity with abundant, atypical, naked nuclei were present. In one case, FNA material was available for ultrastructural studies. It disclosed the characteristic cytoplasmic crystalline structures. A specific cytologic diagnosis of ASPS was given in all cases. In conclusion, ASPS is a rare neoplastic entity that shows a characteristic cytologic image. When accompanied by an adequate clinical context it permits specific preoperative recognition. While immunocytologic studies are helpful to exclude other neoplasms, ultrastructure may result in an exact diagnosis.     

腺泡状软组织肉瘤16例临床病理分析

目的探讨腺泡状软组织肉瘤(alveolar soft part sarcoma,ASPS)的临床病理、免疫表型以及分子遗传学特征。方法对16例ASPS进行临床病理学、细胞化学和免疫表型观察,其中2例行FISH检测。结果 16例ASPS中男性6例,女性10例,发病年龄8~58岁(中位年龄31.7岁),临床表现为局部缓慢生长的肿块。肿瘤发生部位包括四肢、肩背部、舌、声带、肺、子宫颈、输尿管。镜下见典型的器官样或腺泡状结构,形成窦隙状血管及纤维间隔,肿瘤胞质内含丰富嗜酸性颗粒。PAS染色显示肿瘤细胞内可有结晶体形成,免疫组化标记肿瘤细胞TFE3阳性,FISH检测肿瘤细胞存在ASPL-TFE3基因融合。结论 ASPS好发于青少年,肿瘤好发部位为四肢,少见部位(舌、声带、子宫颈、输尿管等)发生的ASPS易被误诊为上皮性恶性肿瘤。病理诊断时需与原发或转移性腺癌、副神经节瘤鉴别。肿瘤细胞形成典型的腺泡状结构并且免疫组化标记TFE3和组织蛋白酶K对诊断有意义,诊断时需结合ASPL-TFE3基因融合检测技术。     

Pediatric alveolar soft part sarcoma of the orbit: a case report

Alveolar soft part sarcoma (ASPS) of the orbit is exceedingly rare and little is known regarding its radiologic features. Here, we reviewed the CT and MRI findings of one case of ASPS of the orbit with emphasis on its salient imaging features.     

Alveolar soft part sarcoma

Summary The type, differentiation and histogenesis of the tumor cells of alveolar soft part sarcoma (ASPS) have been analyzed in a series of ten cases by a light-microscopic, ultrastructural, immunohistochemical and cytologic investigation and quantitative DNA analysis. Four tumors deviated from ordinary ASPS: three were wholly or partly of the so-called pleomorphic variant of ASPS and a fourth tumor showed calcifications of the psammoma body type. The ultrastructural findings and immunohistochemical demonstration of desmin supported the hypothesis of a rhabdomyomatous differentiation and gave no support to epithelial (negative immunoreactions for cytokeratins, epithelial membrane antigen, HMFG-1 and -2, tissue polypeptide antigen (TPA)) or neuroectodermal (negative for S-100 protein, glial fibrillary acidic protein, neurofilaments) differentiation. The negative immunoreactions for vimentin and myoglobin and the positive reaction for neuron specific enolase (NSE) do not exclude a rhabdomyomatous differentiation since in rhabdomyosarcomas the undifferentiated rhabdomyoblasts generally contain vimentin and the differentiated tumor cells contain myoglobin and rhabdomyosarcoma has previously been reported as being positive for NSE. The production of external lamina material peripherally in the tumor cell nests and around vessels in the vascular septa was demonstrated both ultrastructurally and by immunohistochemistry using antibodies against collagen IV and laminin. The cytologic appearance in smears obtained by fine-needle aspiration from a case of the pleomorphic variant showed some resemblance to that of a carcinoma. The seven tumors with an ordinary cell appearance were found to show a diploid DNA-distribution at a quantitative analysis performed on paraffin sections, while the three tumors wholly or partly of the pleomorphic type showed an additional tetraploid peak.     

Alveolar soft part sarcoma

This article provides an overview of the pathology of alveolar soft part sarcoma, focused on its morphology, special stains useful in diagnosis, and the clinical and radiographic features of the disease. Alveolar soft part sarcoma is a rare neoplasm of unknown histogenesis with poor prognosis. Although there are several immunohistochemical stains available to help reach the diagnosis, the morphology of the tumor should be considered the main diagnostic feature. The periodic acid-Schiff stain is the best single stain that supports the diagnosis.     

Alveolar soft part sarcoma

Summary The many different theories on the histogenesis of alveolar soft part sarcoma (ASPS) have caused great confusion. Owing to the recent rapid advance in immunohistochemical studies, two major hypotheses have been proposed. One group of researchers supports the idea that ASPS shows myogenic differentiation, while the other group opposes the idea. This confrontation is essentially one between a group that believes in the immunohistochemically demonstrated presence of desmin in ASPS and a group that denies it. In the present study we detected desmin in 6 of 10 formalin-fixed paraffin sections (although there were differences due to the use of five commercially available types of anti-desmin antibodies). When acetone-fixed paraffin sections and periodate-lysin-paraformaldehyde (PLP)-fixed frozen sections were used in one and three cases, respectively, they were found to be desmin positive, regardless of the type of antibody. The consistent positivity for all anti-desmin antibodies in the cases treated with acetone or PLP is very suggestive of a myogenous origin of ASPS. It is important to take into consideration the fact that formalin-fixed paraffin sections are not very suitable for immunohistochemical study of desmin.     

Metastatic alveolar soft part sarcoma of the lung: Metastatic alveolar soft part sarcoma of the lung‐a morphologic pitfall on cytology and aberrant CD10 expression on histology

Alveolar soft part sarcoma (ASPS) is a rare aggressive soft tissue sarcoma of young adults, typically arising in the deep soft tissue of lower extremities. Although cytomorphology is characteristic enough for an accurate diagnosis in typical clinical scenarios, problems arise when it occurs in older patients, atypical sites, or in primary evaluation at metastatic sites. A 48‐year‐old smoker presented with breathlessness and headache for 2 months. Imaging showed a heterogeneous enhancing lesion of 6 cm × 6 cm in right middle lobe of lung, smaller miliary nodules in bilateral lungs, multiple bilateral cerebral lesions, and a mass of 3 cm × 3 cm in the left thigh. Primary lung carcinoma with brain and thigh metastases was the clinical diagnosis. Fine‐needle aspiration smears of the lung lesion showed cohesive fragments of large cells with a prominent traversing branching capillary network and discohesion at periphery resulting in a pseudo‐papillary appearance. Tumor cells had fine granular to vacuolated cytoplasm, frayed borders, and prominent nucleoli. Trucut biopsy from the same showed a tumor arranged in nests composed of large polygonal cells, immunopositive for CD10. Possibility of metastatic renal cell carcinoma (RCC) was offered. Abdominal imaging was, however, normal. Core biopsy from thigh showed a similar tumor, immunonegative for epithelial markers, with cytoplasmic periodic‐acid‐schiff positive rhomboid crystals, clinching the final diagnosis of ASPS with lung and brain metastases. There is considerable morphological and immunohistochemical overlap between ASPS and RCC. Bare nuclei on air dried smears, binucleation, metachromatic basement membrane material are subtle pointers toward ASPS. Diagn. Cytopathol. 2016;44:250–254. © 2015 Wiley Periodicals, Inc.     

Primary alveolar soft part sarcoma of the stomach: a case report and review

Alveolar soft part sarcoma (ASPS) is a rare tumor typically located in skeletal muscles and muscolofascial planes. Isolated cases of ASPS have been described as arising in the viscera. We report a mesenchymal tumor of the stomach in a 54-year-old Italian woman without evidence of primary neoplasm elsewhere ten years following the initial diagnosis. The histologic, histochemical, immunohistochemical, and electron microscopic findings were all consistent with the diagnosis of ASPS and allowed differentiating it from morphologically similar and more common tumors, such as metastatic renal cell carcinoma and paraganglioma. The patient is alive and well ten years following the initial presentation.     

Primary intraosseous alveolar soft part sarcoma: Report of two cases with radiologic-pathologic correlation

Alveolar soft part sarcoma (ASPS) accounts for less than 1 % of all soft tissue sarcomas. ASPS presents a poor prognosis and develops frequent metastases, especially in the lungs, brain and bones. Current therapies, such as surgery, radiotherapy and chemotherapy, are not fully effective and other alternative treatments are currently being studied. ASPS is predominantly found in the deep soft tissues of the lower extremities. To our knowledge, only thirteen primary intraosseous ASPS have been reported in the literature. In this study, we report two new cases of this exceedingly rare entity. Both cases already had multiple metastases since diagnosis; one of them represents the first case of a primary bone ASPS in the ulna and is also the primary intraosseous ASPS with the longest reported case of survival, after having maintained long periods of stabilization despite not having received any systemic treatment.     

Lingual alveolar soft part sarcoma; 14 cases: novel clinical and morphological observations

AIMS: Alveolar soft part sarcoma (ASPS) is a rare sarcoma in the buttocks or thigh of young adults, often with metastases to lung, brain, or bone. This study examines the morphological and clinical features of lingual ASPS. METHODS AND RESULTS: Fourteen cases, in eight males and six females (ages 3-21 years, median 5 years), ranged from 8 to 50 mm, median 25 mm. All tumours were intramuscular, circumscribed and multinodular. Tumours from all but the oldest patient exhibited a predominantly solid (non-alveolar) growth pattern. Vascular invasion was common. Crystals varied in number from none or extremely rare to nearly 100% of tumour cells. Immunohistochemical results: Fifty percent desmin positive, all focally smooth muscle antigen (SMA) positive; negative for vimentin, neural/melanocytic, myoid, histiocytic, and epithelial markers. All tumours were surgically excised; only two patients received chemotherapy. Follow-up on 10 patients showed that all patients were alive without disease (4-32, median 22 years). Only one patient had a microscopic metastasis to lung (3 years) but was without disease at 11 years. CONCLUSIONS: Lingual ASPS is a tumour of childhood with a distinctive, predominantly solid growth pattern. Despite typical vascular invasion, the early diagnosis and small tumour size may explain its relatively good outcome.     

Alveolar soft part sarcoma of the uterus

A 14-year-old girl presented with menorrhagia. The curettage specimen was extensively necrotic but examination of the subsequent hysterotomy specimen established the diagnosis of alveolar soft part sarcoma of the uterus, a very rare site for this uncommon malignant tumour.     

Alveolar soft part sarcoma of the uterus

Two patients with alveolar soft part sarcoma of the uterus are described. One of the sarcomas was a submucosal nodule of the cervix, and the second was a minuscule, incidentally discovered lesion in the corpus. Both lesions contained periodic acid-Schiff-positive, diastase-resistant cytoplasmic granules, and characteristic membrane-bound crystalline inclusion bodies were demonstrated in the cervical lesion.