Primary testicular osteosarcoma with hydrocele

Primary testicular osteosarcoma is an extremely rare malignancy. To date, only two cases have been reported. Here, we report a third case of primary testicular osteosarcoma complicated with hydrocele. A 78-year-old man presented with right scrotal swelling. Ultrasonography revealed hydrocele and a testicular heterogeneous solid mass with focal calcification in the right testis. Right inguinal orchiectomy revealed a pure intratesticular osteosarcoma. Retroperitoneal lymph-node dissection revealed no metastasis. Thorough sampling of the tumor failed to show any additional histological components. It is unlikely that our case arose from teratoma or mixed sex-cord/stromal tumor, because no other neoplastic elements were identified in whole sampling of the tumor. He remained well without evidence of disease 44 months after operation. This case illustrates that primary pure testicular osteosarcoma may be associated with a favorable prognosis.     

Primary pulmonary rhabdomyosarcoma: report of a case in an adult and review of the literature

A case of primary pulmonary rhabdomyosarcoma occurring in a 62-year-old man is reported, and a review of the literature is presented. The tumor affected the left upper lobe and involved the mediastinal lymph nodes. Immunohistochemical and ultrastructural studies supported the myogenic phenotype of the neoplasm. A left pneumonectomy was performed with complete surgical removal of the tumor. Postoperative radiotherapy was carried out. The patient is currently alive and free of disease 9 months after operation. Despite the rarity of primary pulmonary rhabdomyosarcoma, this tumor should be differentiated from other poorly differentiated pulmonary neoplasms and from metastatic sarcomas.     

Primary sclerosing rhabdomyosarcoma of the scalp and skull: report of a case and review of literature

We present a case of sclerosingrhabdomyosarcoma of the skull in a young male. This is a rare tumor that immunophenotypically shows rhabdomyoid differentiation. The lesion had a moderately aggressive course and the patient died at 19 months after diagnosis.     

回肠转移性骨肉瘤伴局灶横纹肌肉瘤分化一例

患者男,21岁。无明显诱因感上腹部疼痛伴腹胀1个月余,停止排气排便5 d。以“肠梗阻”收入院,腹部CT示肠套叠（回肠-回肠型）并低位小肠梗阻,剖腹探查术中见一隆起型肿物位于回肠内,活动性较差,行肠套叠复位肠切除吻合手术。镜下观察：肿瘤细胞弥漫分布,瘤细胞明显异型,呈梭形、卵圆形,核大深染,部分区域呈条束状排列,核仁明显...     

Primary osteosarcoma in patients older than 40 years of age

Among the 665 patients who registered at our hospital, we reviewed 39 cases of high grade primary osteosarcoma in patients who were older than 40 yr of age. The aim of this study was to determine if a primary osteosarcoma in older patients has different clinical features, and a poorer prognosis than in younger patients. Two evaluations were performed. In the first, an attempt was made to determine the possible prognostic factors such as gender, location, size, alkaline phosphatase, radiological findings, chemotherapy intensity, chemotherapy-induced tumor necrosis, and surgical margin. The second evaluation involved assessment of whether there were any significant clinical differences between older patients and adolescents. According to the results, a primary osteosarcoma in older patients did not reveal any significant prognostic variables. A primary osteosarcoma in older patients showed a poorer prognosis due to relatively unusual locations, common abnormal radiological findings, and a poor response to chemotherapy. Therefore, careful attention should be paid to making an accurate diagnosis and new strategies for more effective treatment, including chemotherapy, must to be developed in order to achieve long term survival in older patients with osteosarcoma.     

Intraoperative cytology of osseous lesions

Cytologic preparations were made from 53 biopsies of osseous and related lesions submitted for intraoperative diagnosis. Smears made by scraping the surface of the lesion and spreading the material obtained on a glass slide were most commonly used. These preparations were found to be valuable adjuncts to frozen sections because cytologic details were so much more clearly visible. Among specific diagnostic features found to be particularly helpful were the large numbers of nuclei found in most of the multinucleated cells from giant-cell tumors but in few osteoclasts from other lesions; the metachromatic staining of osteoid in air-dried, Romanowsky-stained smears from osteosarcomas; and the ease with which multinucleated cells can be identified in smears from chondrosarcomas. The characteristic appearance of chondroblasts from a chondroblastoma; the distinctive appearances of osteoclasts and multinucleated histiocytes from eosinophilic granulomas; the unique appearance of synovial cells from pigmented synovitis; and the ease with which small cells of a metastatic carcinoma could be distinguished from hematopoietic bone-marrow cells were other significant findings. These and other features of the lesions encountered are presented in greater detail.     

Immunohistochemical study of rhabdomyosarcoma. Unexpected staining with S100 protein and cytokeratin

The immunohistochemical study of 60 cases of rhabdomyosarcomas made it possible to test eight different antibodies currently used in tumour pathology: i.e., antisera to vimentin, desmin, myoglobin, cytokeratin, epithelial membrane antigen, S100 protein, neurofilaments, and leukocyte common antigen. Vimentin was found in 58 cases (97 per cent), desmin in 49 cases (82 per cent), myoglobin in 23 cases (38 per cent), S100 protein in 7 cases (12 per cent), and cytokeratin in 3 cases (5 per cent). Other markers were negative. S100 protein was present in large round tumour cells with abundant eosinophilic cytoplasm (round rhabdomyoblasts), whereas cytokeratin was present in small tumour cells similar to those observed in rhabdoid sarcoma. This unexpected staining should become common knowledge for the correct interpretation of the immunohistochemical study of small cell tumours in the young.     

原发性骨外骨肉瘤十例临床病理学研究

目的探讨原发性骨外骨肉瘤(extraskeletal osteosarcoma,ESOS)的临床病理、免疫组织化学及分子病理学特征。方法收集2003年1月至2019年1月福建省立医院诊治的10例ESOS,进行HE、免疫组织化学染色及分子病理学检测,并电话随访及复习相关文献。结果3例女性和7例男性,年龄36~85岁(平均年龄60岁),肿块大小5.5~17.5 cm(平均11.0 cm)。低倍镜下,肿瘤呈结节状、片状、分叶状,肿瘤由梭形细胞、肿瘤性骨样组织、软骨样组织构成,三者比例多少不等,并相互移行,其中见异型性梭形细胞直接产生骨样组织。免疫表型:肿瘤细胞呈SATB2部分阳性(9/9),α-平滑肌肌动蛋白(4/10)和上皮细胞膜抗原(1/10)灶性阳性,Ki-67阳性指数10%~50%,结蛋白、CD68、S-100蛋白、SOX10、HMB45、CD117、DOG1、CD34、广谱细胞角蛋白(CKpan)、GATA3及PAX8均阴性。分子病理检测:未检测到MDM2/CDK4基因扩增信号(0/6);未见SSX18基因分离信号(0/5);未检测到C-KIT和PDGFR-α突变信号(0/3)。结论ESOS属于骨外成骨性肿瘤,诊断需临床、影像、病理学相结合,必要时免疫组织化学及分子病理检测辅助诊断。     

Osteosarcoma with features mimicking malignant fibrous histiocytoma

Summary Three osteosarcomas (OS) with features resembling malignant fibrous histiocytoma (MFH) were selected and investigated to identify any clinico-pathological similarities. In all cases there was no significant difference from conventional OS on the radiography and laboratory data. The appearance of MFH-like features within the whole tumour tissue varied from 7% to 55%. It was composed of spindle-shaped cells arranged in short irregular fascicles and a storiform pattern admixed with osteoclast-like giant cells, but devoid of neoplastic osteoid. Such spindle-shaped cells had a poorly developed rough endoplasmic reticulum and expressed a strong alkaline phosphatase activity as well as vimentin. A series of allografts to athymic mice using the MFH-like tissues also showed histologically a proliferation of plump spindle-shaped cells with a storiform pattern lacking osteoclast-like giant cells, and intensely positive for alkaline phosphatase. These findings indicate that the MFH-like features are identified as modulated OS. The constituting cells are most likely to be poorly developed with possible phenotypic alteration in the maturation stage of osteoblastic cell lineage, but different from conventional MFH of bone as regards their distinct histochemical pattern.     

硬化性横纹肌肉瘤的临床病理学分析

目的探讨硬化性横纹肌肉瘤（SRMS）的临床病理学特征,以及与胚胎性横纹肌肉瘤（ERMS）和腺泡状横纹肌肉瘤（ARMS）之间的关系。方法观察4例SRMS的临床特点、光镜形态,以免疫组织化学染色[En Vision法;波形蛋白、结蛋白、α-平滑肌肌动蛋白（α-SMA）、肌特异性肌动蛋白（MSA）、生肌蛋白、肌调节蛋白（MyoD1）、高分子量钙调结合蛋白（h-CALD）、CD31、CD34、第Ⅷ因子相关抗原、S-100蛋白、细胞角蛋白（AE1／AE3）和问变性大细胞淋巴瘤激酶（ALK1）]确定免疫学表型。结果4例均发生于成年人,平均年龄41．5岁。男性2例,女性2例。肿瘤分别位于左腕部、右大腿、右颊部和右面部,直径大小为2．5—10．0cm,平均5．7cm。镜下以含有大量玻璃样变的基质为特征,类似原始的骨样组织或软骨样基质。瘤细胞主要由原始的小圆形细胞组成,其排列方式呈多样化,包括条束状、索状、列兵样、梁状、微腺泡状和假血管样排列等。除1例可见少量的横纹肌母细胞外,其余3例均未见横纹肌母细胞,也未见花环状多核巨细胞。2例的局部区域还含有梭形细胞成分,其中1例类似梭形细胞横纹肌肉瘤,另1例类似周围神经肿瘤。免疫组织化学标记显示,瘤细胞弥漫强阳性表达MyoD1,而结蛋白多为灶性表达,生肌蛋白多为阴性或仅为灶性阳性。3例表达MSA,2例表达Ot-SMA,但不表达h-CALD。S-100蛋白、CD31和ALK1等标记均为阴性。结论SRMS在形态上和免疫学表型上与ERMS和ARMS均有所不同,但在细胞遗传学上与ERMS关系密切。熟悉SRMS的形态特征和免疫学表型有助于识别这种少见的横纹肌肉瘤亚型及与其他硬化性肿瘤相鉴别。     

Bone formation in vitro and in nude mice by human osteosarcoma cells

Osteosarcomas contain variable amounts of bony tissue, but the mechanism of bone formation by osteosarcoma is not well understood. While a number of cultured human osteosarcoma cell lines have been established, they are maintained by different media and differ qualitatively with regard to bone formation. We examined different media for their ability to support bone formation in vitro and found that alpha-modification of Eagle's minimal essential medium supplemented with beta glycerophosphate was best for this purpose, because it contained the proper calcium and phosphate concentrations. Subsequently, we compared seven human osteosarcoma cell lines under the same experimental conditions to clarify their ability to induce bone formation. NOS-1 cells most frequently exhibited features of bone formation in vitro and in nude mice. Collagen synthesis by tumour cells themselves seemed to be the most important factor for bone volume. However, even HuO9 cells, which lacked collagen synthesis and failed to form bone in vitro, successfully formed tumours containing bone in nude mice. Histological analysis of HuO9 cells in diffusion chambers implanted in nude mice and the findings of polymerase chain reaction indicated that the phenomenon was probably due to bone morphogenetic protein.     

Chromosomal and genetic imbalances in Chinese patients with rhabdomyosarcoma detected by high-resolution array comparative genomic hybridization

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children. Although associations between ARMS tumorigenesis and PAX3, PAX7, and FKHR are well recognized, the complete genetic etiology underlying RMS pathogenesis and progression remains unclear. Chromosomal copy number variations (CNVs) and the involved genes may play important roles in the pathogenesis and progression of human malignancies. Using high-resolution array comparative genomic hybridization (aCGH), we examined 20 formalin-fixed, paraffin-embedded (FFPE) RMS tumors to explore the involvement of the relevant chromosomal regions with resident genes in RMS tumorigenesis. In RMS, frequent gains were identified on chromosome regions 12q13.3-q14.1, 12q24.31, 17q25.1, 1q21.1, and 7q11.23, whereas frequent losses were observed on chromosome regions 5q13.2, 14q32.33, and 15q11.2. Amplifications were observed on chromosome regions 9p13.3, 12q13.3-q14.1, 12q15, and 16p13.11, whereas deletions were detected on chromosome regions 1p36.33, 1p13.1, 2q11.1, 5q13.2, 8p23.1, 9p24.3, and 16p11.2. Frequent gains were detected in GLI1, GEFT, OS9, and CDK4 (12q13.3-q14.1), being 60% in embryonal rhabdomyosarcoma (ERMS) and 66.67% in alveolar rhabdomyosarcoma (ARMS), respectively. However, frequent losses were detected in IGHG1, IGHM, IGHG3, and IGHG4 (14q32.33), being 70% in ERMS and 55.56% in and ARMS, respectively. Frequent gains were detected in TYROBP, HCST, LRFN3, and ALKBH6 (19q13.12) in ERMS but not in ARMS. The frequency of TYROBP, HCST, LRFN3, and ALKBH6 gains is significantly different in ERMS versus ARMS (P=0.011). The results suggest that novel TYROBP, HCST, LRFN3, and ALKBH6 genes may play important roles in ERMS. The technique used is a feasible approach for array comparative genomic hybridization analysis in archival tumor samples.     

MicroRNA expression in relation with clinical evolution of osteosarcoma

Osteosarcoma is the most common malignant bone tumor. Early diagnosis remains a major challenge, mainly because of the lack of specific biomarkers. We performed miRNAs expression analysis through qPCR in affected and paired healthy bone derived from osteosarcoma patients. Hierarchical clustering using the top ten miRNAs with differential expression showed two main clusters. One integrated by patients with the presence of metastasis or relapse and the other without these complications. Further pathway enrichment analysis reduced to four main miRNAs, hsa-miR-486-3p, hsa-miR-355-5p, hsa-miR-34a-5p and hsa-miR-1228-3p. Afterwards, we compared patients with and without metastasis, the function enrichment analysis along with review of relevant literature, showed that hsa-miR-93-5p and hsa-miR-28-5p were associated with metastasis development. Our results support the relevance of miRNAs in the pathogenesis of osteosarcoma and contribute with evidence regarding the potential role of miRNAs as potential biomarkers. More studies are needed to define the most informative miRNAs in osteosarcoma patients.     

Association of ERCC gene polymorphism with osteosarcoma risk

BackgroundThe relationship between ERCC gene polymorphism and osteosarcoma risk / overall survival of osteosarcoma is still conflicting, and this meta-analysis was performed to assess these associations.Material and methodsThe association studies were identified from PubMed, and eligible reports were included and calculated using meta-analysis method.ResultsFour studies were included for the association of ERCC gene polymorphism with osteosarcoma risk, and nine studies were recruited into this meta-analysis for the relationship between ERCC gene polymorphism and overall survival of osteosarcoma. The meta-analysis indicated that ERCC1 rs3212986 (8092 C>A) gene polymorphism, ERCC1 rs11615 (19007 T>C) gene polymorphism, ERCC2 rs1799793 (A>G) gene polymorphism, ERCC2 rs13181 (Lys751Gln) gene polymorphism were not associated with osteosarcoma risk. ERCC1 rs2298881 (C>A) gene polymorphism, ERCC1 rs3212986 (8092 C>A) gene polymorphism, ERCC1 rs11615 (19007 T>C) gene polymorphism, ERCC2 rs1799793 (Asp312Asn) gene polymorphism were not associated with overall survival of osteosarcoma. Interestingly, ERCC2 rs13181 A allele and GG genotype were associated with overall survival of osteosarcoma, but AA genotype not (A allele: OR = 0.78, 95% CI: 0.65–0.93, P = 0.007; GG genotype: OR = 1.32, 95% CI: 1.05–1.65, P = 0.02; AA genotype: OR = 0.69, 95% CI: 0.45–1.04, P = 0.08).ConclusionERCC2 rs13181 A allele and GG genotype were associated with overall survival of osteosarcoma.     

Clinical results of high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation in children with advanced stage rhabdomyosarcoma

Regardless of improvement in cure of Rhabdomyosarcoma (RMS), the results in treatment of advanced stage of RMS in children are still dismal. Recently, high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (HDC/APBSCT) has been tried to manage the advanced high-risk RMS patients. We investigated the effectiveness of HDC/APBSCT by reviewing the clinical records of high-risk pediatric RMS patients in single institute database. Over twenty years, 37 patients were diagnosed as RMS with high-risk at the time of first diagnosis. These patients were classified as two groups according to treatment method. The first group was HDC/APBSCT and the other was conventional multi-agent chemotherapy group. Differences of clinical results between the two groups were analyzed. The median age of patients was 5 yr, ranging from 6 months to 15 yr. The 5-yr event free survival rate (EFS) of all patients was 24.8% ± 4.8%. HDC/APBSCT group and conventional multi-agent chemotherapy group were 41.3% ± 17.8% and 16.7% ± 7.6% for 5-yr EFS, respectively (P = 0.023). There was a significant difference in the result of HDC/APBSCT between complete remission or very good partial response group and poor response group (50% ± 20.4% vs 37.5% ± 28.6%, P = 0.018). HDC/APBSCT can be a promising treatment modality in high-risk RMS patients.     

Cardiac differentiation of cardiosphere-derived cells in scaffolds mimicking morphology of the cardiac extracellular matrix

Stem cell therapy has the potential to regenerate heart tissue after myocardial infarction (MI). The regeneration is dependent upon cardiac differentiation of the delivered stem cells. We hypothesized that timing of the stem cell delivery determines the extent of cardiac differentiation as cell differentiation is dependent on matrix properties such as biomechanics, structure and morphology, and these properties in cardiac extracellular matrix (ECM) continuously vary with time after MI. In order to elucidate the relationship between ECM properties and cardiac differentiation, we created an in vitro model based on ECM-mimicking fibers and a type of cardiac progenitor cell, cardiosphere-derived cells (CDCs). A simultaneous fiber electrospinning and cell electrospraying technique was utilized to fabricate constructs. By blending a highly soft hydrogel with a relatively stiff polyurethane and modulating fabrication parameters, tissue constructs with similar cell adhesion property but different global modulus, single fiber modulus, fiber density and fiber alignment were achieved. The CDCs remained alive within the constructs during a 1 week culture period. CDC cardiac differentiation was dependent on the scaffold modulus, fiber volume fraction and fiber alignment. Two constructs with relatively low scaffold modulus, ∼50–60 kPa, most significantly directed the CDC differentiation into mature cardiomyocytes as evidenced by gene expressions of cardiac troponin T (cTnT), calcium channel (CACNA1c) and cardiac myosin heavy chain (MYH6), and protein expressions of cardiac troponin I (cTnI) and connexin 43 (CX43). Of these two low-modulus constructs, the extent of differentiation was greater for lower fiber alignment and higher fiber volume fraction. These results suggest that cardiac ECM properties may have an effect on cardiac differentiation of delivered stem cells.     

儿童四肢骨肉瘤保肢治疗临床疗效分析

目的 探讨儿童四肢骨肉瘤保肢治疗临床疗效情况。方法 回顾性分析2010年1月至2021年10月新疆医科大学附属肿瘤医院儿童四肢骨肉瘤保肢患者的临床资料。随访时间6 ～ 116个月,平均随访时间为（30.0±27.5）个月,中位生存时间为47个月。根据随访结果,分析儿童四肢骨肉瘤的发生部位、术前碱性磷酸酶、Enneking分期、手术方式、肿瘤最大直径、病理类型、是否规律完成化疗、是否局部复发以及术后肺转移情况等因素对患者预后的影响。采用单因素及多因素分析影响儿童四肢骨肉瘤保肢预后的因素。结果 男女比例为1.2∶1,1年内总生存率为82.7%,3年内总生存率为53.6%,5年内总生存率为40.5%。经分析显示肿瘤最大直径≥10 cm、是否规律完成化疗、肿瘤坏死率及肺转移情况是影响儿童四肢骨肉瘤保肢患者预后的独立危险因素（P＜0.05）。结论 肿瘤最大直径、是否规律完成化疗、肿瘤坏死率及肺转移情况可明确影响儿童四肢骨肉瘤保肢患者预后,因此早发现、早治疗以及全程规律地完成化疗并预防肺转移的发生是治疗骨肉瘤的关键。     

Overexpression of GEFT,a Rho family guanine nucleotide exchange factor,predicts poor prognosis in patients with rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is one of the most common soft-tissue sarcomas in children and adolescents with poor prognosis. Yet, there is lack of effective prognostic biomarkers for RMS. The present study, therefore, aimed to explore potential biomarkers for RMS based on our previous findings using array comparative genomic hybridization. We investigated guanine nucleotide exchange factor, GEFT, at expression level in 45 RMS patients and 36 normal striated muscle controls using immunohistochemistry using tissue microarrays. The expression rate of GEFT in RMS samples (42/45, 93.33%) was significantly higher (P<0.05) than that in normal controls (5/36, 13.89%). Moreover, the overexpression rate of GEFT in RMS (31/45, 68.89%) was also significantly higher (P<0.05) than that in normal controls (0/36, 0.00%). Increased expression of GEFT correlated significantly with advanced disease stages (stages III/IV) (P=0.001), lymph node metastasis (P=0.019), and distant metastasis (P=0.004), respectively, in RMS patients. In addition, RMS patients having overexpressed GEFT experienced worse overall survival (OS) than those having low levels of GEFT (P=0.001). GEFT overexpression was determined to be an independent prognostic factor for poor OS in RMS patients (hazard ratio: 3.491, 95% confidence interval: 1.121-10.871, P=0.004). In conclusion, these observations provide the first evidence of GEFT overexpression in RMS and its correlations with disease aggressiveness and metastasis. These findings suggest that GEFT may serve as a promising biomarker predicting poor prognosis in RMS patients, thus implying its potential as a therapeutic target.     

Long non-coding RNA HOTTIP is up-regulated and associated with poor prognosis in patients with osteosarcoma

Long non-coding RNAs (lncRNAs) have been shown to play key roles in cancer development and progression. In this study, we focused on lncRNA HOTTIP and investigated its expression pattern, clinical significance, and biological function in osteosarcoma (OS). In the present study, lncRNA HOTTIP expression in OS tissues was examined and its correlation with clinicopathological features and patient prognosis was analyzed. In vitro assays were performed to understand the biological roles of lncRNA HOTTIP in OS progression. In the study, we found that HOTTIP expression was up-regulated in OS tissues, and correlated with advanced clinical stage and distant metastasis. OS patients with high HOTTIP expression level had poorer overall survival than those with low HOTTIP expression. Multivariable Cox proportional hazards regression analysis suggested that increased HOTTIP expression was an independent prognostic factor of overall survival in OS patients. Moreover, the results of in vitro assays showed that the suppression of HOTTIP in OS cells significantly reduced cell proliferation, migration and invasion ability. Our study demonstrated that lncRNA HOTTIP play critical roles in OS progression and could represent a novel prognostic marker and potential therapeutic target in OS patients.