Small cell osteosarcoma (SCOS), a variant of conventional high-grade osteosarcoma (COS), may mimic fusion-driven round cell sarcomas (FDRCS) by overlapping clinico-radiological and... Show moreSmall cell osteosarcoma (SCOS), a variant of conventional high-grade osteosarcoma (COS), may mimic fusion-driven round cell sarcomas (FDRCS) by overlapping clinico-radiological and histomorphological/immunohistochemical characteristics, hampering accurate diagnosis and consequently proper therapy. We retrospectively analyzed decalcifed formalin-fxed parafn-embedded (FFPE) samples of 18 bone tumors primarily diagnosed as SCOS by methylation profling, fusion gene analysis, and immunohistochemistry. In eight cases, the diagnosis of SCOS was maintained, and in 10 cases it was changed into FDRCS, including three Ewing sarcomas (EWSR1::FLI1 in two cases and no identifed fusion gene in the third case), two sarcomas with BCOR alterations (KMT2D::BCOR, CCNB3::BCOR, respectively), three mesenchymal chondrosarcomas (HEY1::NCOA2 in two cases and one case with insufcient RNA quality), and two sclerosing epithelioid fbrosarcomas (FUS::CREBL3 and EWSR1 rearrangement, respectively). Histologically, SCOS usually possessed more pleomorphic cells in contrast to the FDRCS showing mainly monomorphic cellular features. However, osteoid was seen in the latter tumors as well, often associated with slight pleomorphism. Also, the immunohistochemical profle (CD99, SATB2, and BCOR) overlapped. Clinically and radiologically, similarities between SCOS and FDRCS were observed, with by imaging only minimal presence or lack of (mineralized) osteoid in most of the SCOSs. In conclusion, discrimination of SCOS, epigenetically related to COS, versus FDRCS of bone can be challenging but is important due to diferent biology and therefore therapeutic strategies. Methylation profling is a reliable and robust diagnostic test especially on decalcifed FFPE material. Subsequent fusion gene analysis and/or use of specifc immunohistochemical surrogate markers can be used to substantiate the diagnosis. Show less
ObjectivesEarly, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is... Show moreObjectivesEarly, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions.Materials and methodsA validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” was achieved.ResultsEight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers.ConclusionUltrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. Show less
Infantile fibrosarcoma (IFS) and congenital mesoblastic nephroma (CMN) are locally aggressive tumors primarily occurring in infants. Both IFS and the cellular subtype of CMN show overlapping... Show moreInfantile fibrosarcoma (IFS) and congenital mesoblastic nephroma (CMN) are locally aggressive tumors primarily occurring in infants. Both IFS and the cellular subtype of CMN show overlapping morphological features and an ETV6-NTRK3 fusion, suggesting a close relationship. An activating alteration of EGFR, based on an EGFR kinase domain duplication (KDD), occurs in a subset of CMNs lacking an NTRK3 rearrangement, especially in the classic and mixed type. So far no EGFR-KDDs have been detected in IFS.We describe four pediatric tumors at the extremities (leg, n = 2; foot and arm n = 1) with histological features of IFS/CMN. Two cases showed classic IFS morphology while two were similar to classic/mixed type CMN. In all cases, an EGFR-KDD was identified without detection of a fusion gene. There were no abnormalities of the kidneys in any of the patients.This is the first description of IFS with an EGFR-KDD as driver mutation, supporting that IFS and CMN are similar lesions with the same morphological and genetic spectrum. Pathologists should be aware of the more fibrous variant of IFS, similar to classic/mixed type CMN. Molecular analyses are crucial to treat these lesions adequately, especially with regard to the administration of tyrosine kinase inhibitors. Show less
Due to a lack of patient materials and ethical reasons animal models of BPD are critical for characterization the pathophysiology of BPD and testing of potential treatment options. In chapter 2 of... Show moreDue to a lack of patient materials and ethical reasons animal models of BPD are critical for characterization the pathophysiology of BPD and testing of potential treatment options. In chapter 2 of this thesis we characterize a rat model for experimental BPD, induced in neonatal pups by prolonged exposure to hyperoxia, by investigating histopathology and differential gene expression profiles in the lung and demonstrate its significance for studying BPD in premature infants. In chapter 3 we describe the spatial and temporal expression of surfactant proteins in this experimental BPD model. Since inflammation and unbalanced coagulation and fibrinolysis, leading to extravascular fibrin deposition in the lung, are two interrelated processes that play a pivotal role in the pathophysiology of inflammatory lung disease, we investigated whether the pathophysiology of experimental BPD could be improved by interrupting the vicious cycle of inflammation and coagulation. Fibrin deposition can be prevented directly via inhibition of the coagulation cascade and/or stimulation of the fibrinolytic cascade or indirectly via inhibition of the inflammatory response, thereby preventing activated leucocytes to perform their procoagulant and antifibrinolytic activity. In chapters 4 and 5 intervention studies in experimental BPD are described which study the potential therapeutic effect of agents with anti-inflammatory and/or anticoagulant activity for premature infants who are at risk of developing BPD. The role of pentoxifylline, a methylxantine derivative and weak non-selective phosphodiesterase inhibitor with anti-inflammatory and anticoagulant properties, and with positive effects on capillary blood flow in experimental BPD is presented in chapter 4. The role of nitric oxide, a gas that is involved in multiple (patho)physiological processes in the injured lung, including pulmonary vasodilatation, inflammation and plasma exudation, is presented in chapter 5. In chapter 6 the presented studies of chapters 2-5 and the future perspectives are discussed. In chapter 7 a summary is given of this thesis. Due to a lack of patient materials and ethical reasons animal models of BPD are critical for characterization the pathophysiology of BPD and testing of potential treatment options. In chapter 2 of this thesis we characterize a rat model for experimental BPD, induced in neonatal pups by prolonged exposure to hyperoxia, by investigating histopathology and differential gene expression profiles in the lung and demonstrate its significance for studying BPD in premature infants. In chapter 3 we describe the spatial and temporal expression of surfactant proteins in this experimental BPD model. Since inflammation and unbalanced coagulation and fibrinolysis, leading to extravascular fibrin deposition in the lung, are two interrelated processes that play a pivotal role in the pathophysiology of inflammatory lung disease, we investigated whether the pathophysiology of experimental BPD could be improved by interrupting the vicious cycle of inflammation and coagulation. Fibrin deposition can be prevented directly via inhibition of the coagulation cascade and/or stimulation of the fibrinolytic cascade or indirectly via inhibition of the inflammatory response, thereby preventing activated leucocytes to perform their procoagulant and antifibrinolytic activity. In chapters 4 and 5 intervention studies in experimental BPD are described which study the potential therapeutic effect of agents with anti-inflammatory and/or anticoagulant activity for premature infants who are at risk of developing BPD. The role of pentoxifylline, a methylxantine derivative and weak non-selective phosphodiesterase inhibitor with anti-inflammatory and anticoagulant properties, and with positive effects on capillary blood flow in experimental BPD is presented in chapter 4. The role of nitric oxide, a gas that is involved in multiple (patho)physiological processes in the injured lung, including pulmonary vasodilatation, inflammation and plasma exudation, is presented in chapter 5. In chapter 6 the presented studies of chapters 2-5 and the future perspectives are discussed. In chapter 7 a summary is given of this thesis. Due to a lack of patient materials and ethical reasons animal models of BPD are critical for characterization the pathophysiology of BPD and testing of potential treatment options. In chapter 2 of this thesis we characterize a rat model for experimental BPD, induced in neonatal pups by prolonged exposure to hyperoxia, by investigating histopathology and differential gene expression profiles in the lung and demonstrate its significance for studying BPD in premature infants. In chapter 3 we describe the spatial and temporal expression of surfactant proteins in this experimental BPD model. Since inflammation and unbalanced coagulation and fibrinolysis, leading to extravascular fibrin deposition in the lung, are two interrelated processes that play a pivotal role in the pathophysiology of inflammatory lung disease, we investigated whether the pathophysiology of experimental BPD could be improved by interrupting the vicious cycle of inflammation and coagulation. Fibrin deposition can be prevented directly via inhibition of the coagulation cascade and/or stimulation of the fibrinolytic cascade or indirectly via inhibition of the inflammatory response, thereby preventing activated leucocytes to perform their procoagulant and antifibrinolytic activity. In chapters 4 and 5 intervention studies in experimental BPD are described which study the potential therapeutic effect of agents with anti-inflammatory and/or anticoagulant activity for premature infants who are at risk of developing BPD. The role of pentoxifylline, a methylxantine derivative and weak non-selective phosphodiesterase inhibitor with anti-inflammatory and anticoagulant properties, and with positive effects on capillary blood flow in experimental BPD is presented in chapter 4. The role of nitric oxide, a gas that is involved in multiple (patho)physiological processes in the injured lung, including pulmonary vasodilatation, inflammation and plasma exudation, is presented in chapter 5. In chapter 6 the presented studies of chapters 2-5 and the future perspectives are discussed. In chapter 7 a summary is given of this thesis. Due to a lack of patient materials and ethical reasons animal models of BPD are critical for characterization the pathophysiology of BPD and testing of potential treatment options. In chapter 2 of this thesis we characterize a rat model for experimental BPD, induced in neonatal pups by prolonged exposure to hyperoxia, by investigating histopathology and differential gene expression profiles in the lung and demonstrate its significance for studying BPD in premature infants. In chapter 3 we describe the spatial and temporal expression of surfactant proteins in this experimental BPD model. Since inflammation and unbalanced coagulation and fibrinolysis, leading to extravascular fibrin deposition in the lung, are two interrelated processes that play a pivotal role in the pathophysiology of inflammatory lung disease, we investigated whether the pathophysiology of experimental BPD could be improved by interrupting the vicious cycle of inflammation and coagulation. Fibrin deposition can be prevented directly via inhibition of the coagulation cascade and/or stimulation of the fibrinolytic cascade or indirectly via inhibition of the inflammatory response, thereby preventing activated leucocytes to perform their procoagulant and antifibrinolytic activity. In chapters 4 and 5 intervention studies in experimental BPD are described which study the potential therapeutic effect of agents with anti-inflammatory and/or anticoagulant activity for premature infants who are at risk of developing BPD. The role of pentoxifylline, a methylxantine derivative and weak non-selective phosphodiesterase inhibitor with anti-inflammatory and anticoagulant properties, and with positive effects on capillary blood flow in experimental BPD is presented in chapter 4. The role of nitric oxide, a gas that is involved in multiple (patho)physiological processes in the injured lung, including pulmonary vasodilatation, inflammation and plasma exudation, is presented in chapter 5. In chapter 6 the presented studies of chapters 2-5 and the future perspectives are discussed. In chapter 7 a summary is given of this thesis. Show less
