The evolving classification of soft tissue tumours – an update based on the new 2013 WHO classification
Corresponding Author
Christopher D M Fletcher
Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
Department of Pathology, Harvard Medical School, Boston, MA, USA
Address for correspondence: C D M Fletcher MD, FRCPath, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. e-mail: [email protected]Search for more papers by this authorCorresponding Author
Christopher D M Fletcher
Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
Department of Pathology, Harvard Medical School, Boston, MA, USA
Address for correspondence: C D M Fletcher MD, FRCPath, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. e-mail: [email protected]Search for more papers by this authorAbstract
The new World Health Organization (WHO) classification of soft tissue tumours was published in early 2013, almost 11 years after the previous edition. While the number of newly recognized entities included for the first time is fewer than that in 2002, there have instead been substantial steps forward in molecular genetic and cytogenetic characterization of this family of tumours, leading to more reproducible diagnosis, a more meaningful classification scheme and providing new insights regarding pathogenesis, which previously has been obscure in most of these lesions. This brief overview summarizes changes in the classification in each of the broad categories of soft tissue tumour (adipocytic, fibroblastic, etc.) and also provides a short summary of newer genetic data which have been incorporated in the WHO classification.
References
- 1Fletcher CDM, Unni KK, Mertens F eds. World Health Organization classification of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press, 2002.
- 2Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F eds. World Health Organization classification of tumours of soft tissue and bone, 4th edn. Lyon: IARC Press, 2013.
- 3Erickson-Johnson MR, Chou MM, Evers BR et al. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9–USP6 gene fusion. Lab. Invest. 2011; 91; 1427–1433.
- 4Oliveira AM, Hsi BL, Weremowicz S et al. USP6 (Tre2) fusion oncogenes in aneurysmal bone cyst. Cancer Res. 2004; 64; 1920–1923.
- 5Guillou L, Benhattar J, Gengler C et al. Translocation-positive low-grade fibromyxoid sarcoma: clinicopathologic and molecular analysis of a series expanding the morphologic spectrum and suggesting potential relationship to sclerosing epithelioid fibrosarcoma: a study from the French Sarcoma Group. Am. J. Surg. Pathol. 2007; 31; 1387–1402.
- 6Doyle LA, Wang WL, Dal Cin P et al. MUC4 is a sensitive and extremely useful marker for sclerosing epithelioid fibrosarcoma: association with FUS gene rearrangement. Am. J. Surg. Pathol. 2012; 36; 1444–1451.
- 7Wang WL, Evans HL, Meis JM et al. FUS rearrangements are rare in ‘pure’ sclerosing epithelioid fibrosarcoma. Mod. Pathol. 2012; 25; 846–853.
- 8Chakrapani A, Warrick A, Nelson D et al. BRAF and KRAS mutations in sporadic glomus tumours. Am. J. Dermatopathol. 2012; 34; 533–535.
- 9Brems H, Park C, Maertens O et al. Glomus tumours in neurofibromatosis type 1: genetic, functional and clinical evidence of a novel association. Cancer Res. 2009; 69; 7393–7401.
- 10Mosquera JM, Sboner A, Zhang L et al. Novel MIR143–NOTCH fusions in benign and malignant glomus tumours. Genes Chromosom. Cancer 2013; 52; 1075–1087.
- 11Mosquera JM, Sboner A, Zhang L et al. Recurrent NCOA2 gene rearrangements in congenital/infantile spindle cell rhabdomyosarcoma. Genes Chromosom. Cancer 2013; 52; 538–550.
- 12Hornick JL, Fletcher CD. Pseudomyogenic hemangioendothelioma: a distinctive, often multicentric tumour with indolent behavior. Am. J. Surg. Pathol. 2011; 35; 190–201.
- 13Billings SD, Folpe AL, Weiss SW. Epithelioid sarcoma-like hemangioendothelioma. Am. J. Surg. Pathol. 2003; 27; 48–57.
- 14Trombetta D, Magnusson L, von Steyern FV et al. Translocation t(7;19)(q22;q13) – a recurrent chromosome aberration in pseudomyogenic hemangioendothelioma? Cancer Genet. 2011; 204; 211–215.
- 15Demetri GD, von Mehren M, Antonescu CR et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumours. J. Natl Compr. Canc. Netw. 2010; 8(Suppl. 2); S1–S41.
- 16Gill AJ, Chou A, Vilain R et al. Immunohistochemistry for SDHB divides gastrointestinal stromal tumours (GISTs) into 2 distinct types. Am. J. Surg. Pathol. 2010; 34; 636–644.
- 17Janeway KA, Kim SY, Lodish M et al. Defects in succinate dehydrogenase in gastrointestinal stromal tumours lacking KIT and PDGFRA mutations. Proc. Natl Acad. Sci. USA 2011; 108; 314–318.
- 18Miettinen M, Wang ZF, Sarlomo-Rikala M et al. Succinate dehydrogenase-deficient GISTs: a clinicopathologic, immunohistochemical and molecular genetic study of 66 gastric GISTs with predilection to young age. Am. J. Surg. Pathol. 2011; 35; 1712–1721.
- 19Wagner AJ, Remillard SP, Zhang YX et al. Loss of expression of SDHA predicts SDHA mutations in gastrointestinal stromal tumours. Mod. Pathol. 2013; 26; 289–294.
- 20Dwight T, Benn DE, Clarkson A et al. Loss of SDHA expression identifies SDHA mutations in succinate dehydrogenase-deficient gastrointestinal stromal tumours. Am. J. Surg. Pathol. 2013; 37; 226–233.
- 21Hornick JL, Bundock EA, Fletcher CD. Hybrid schwannoma/perineurioma: clinicopathologic analysis of 42 distinctive benign nerve sheath tumours. Am. J. Surg. Pathol. 2009; 33; 1554–1561.
- 22Feany MB, Anthony DC, Fletcher CD. Nerve sheath tumours with hybrid features of neurofibroma and schwannoma: a conceptual challenge. Histopathology 1998; 32; 405–410.
- 23Harder A, Wesemann M, Hagel C et al. Hybrid neurofibroma/schwannoma is overrepresented among schwannomatosis and neurofibromatosis patients. Am. J. Surg. Pathol. 2012; 36; 702–709.
- 24Fetsch JF, Laskin WB, Miettinen M. Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumour with a predilection for the fingers and toes. Hum. Pathol. 2001; 32; 704–714.
- 25Hollmann TJ, Bovée JV, Fletcher CD. Digital fibromyxoma (superficial acral fibromyxoma): a detailed characterization of 124 cases. Am. J. Surg. Pathol. 2012; 36; 789–798.
- 26Marshall-Taylor C, Fanburg-Smith JC. Hemosiderotic fibrohistiocytic lipomatous lesion: ten cases of a previously undescribed fatty lesion of the foot/ankle. Mod. Pathol. 2000; 13; 1192–1199.
- 27Browne TJ, Fletcher CD. Haemosiderotic fibrolipomatous tumour (so-called haemosiderotic fibrohistiocytic lipomatous tumour): analysis of 13 new cases in support of a distinct entity. Histopathology 2006; 48; 453–461.
- 28Hallor KH, Sciot R, Staaf J et al. Two genetic pathways, t(1;10) and amplification of 3p11-12 in myxoinflammatory fibroblastic sarcoma, haemosiderotic fibrolipomatous tumour and morphologically similar lesions. J. Pathol. 2009; 217; 716–727.
- 29Antonescu CR, Zhang L, Nielsen GP et al. Consistent t(1;10) with rearrangements of TGFBR3 and MGEA5 in both myxoinflammatory fibroblastic sarcoma and hemosiderotic fibrolipomatous tumour. Genes Chromosom. Cancer 2011; 50; 757–764.
- 30Weidner N, Santa Cruz D. Phosphaturic mesenchymal tumours. A polymorphous group causing osteomalacia or rickets. Cancer 1987; 59; 1442–1454.
10.1002/1097-0142(19870415)59:8<1442::AID-CNCR2820590810>3.0.CO;2-Q CAS PubMed Web of Science® Google Scholar
- 31Folpe AL, Fanburg-Smith JC, Billings SD et al. Most osteomalacia-associated mesenchymal tumours are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am. J. Surg. Pathol. 2004; 28; 1–30.
- 32Bahrami A, Weiss SW, Montgomery E et al. RT–PCR analysis for FGF23 using paraffin sections in the diagnosis of phosphaturic mesenchymal tumours with and without known tumour-induced osteomalacia. Am. J. Surg. Pathol. 2009; 33; 1348–1354.
- 33Fletcher CD. Undifferentiated sarcomas: what to do? And does it matter? A surgical pathology perspective Ultrastruct. Pathol. 2008; 32; 31–36.
- 34Sakharpe A, Lahat G, Gulamhusein T et al. Epithelioid sarcoma and unclassified sarcoma with epithelioid features: clinicopathological variables, molecular markers and a new experimental model. Oncologist 2011; 16; 512–522.
- 35Italiano A, Sung YS, Zhang L et al. High prevalence of CIC fusion with double-homeobox (DUX4) transcription factors in EWSR1-negative undifferentiated small blue round cell sarcomas. Genes Chromosom. Cancer 2012; 51; 207–218.
- 36Graham C, Chilton-MacNeill S, Zielenska M, Somers GR. The CIC–DUX4 fusion transcript is present in a subgroup of pediatric primitive round cell sarcomas. Hum. Pathol. 2012; 43; 180–189.
- 37Robinson DR, Wu YM, Kalyana-Sundaram S et al. Identification of recurrent NAB2–STAT6 gene fusions in solitary fibrous tumour by integrative sequencing. Nat. Genet. 2013; 45; 180–185.
- 38Chmielecki J, Crago AM, Rosenberg M et al. Whole-exome sequencing identifies a recurrent NAB2–STAT6 fusion in solitary fibrous tumours. Nat. Genet. 2013; 45; 131–132.
- 39Schweizer L, Koelsche C, Sahm F et al. Meningeal hemangiopericytoma and solitary fibrous tumours carry the NAB2–STAT6 fusion and can be diagnosed by nuclear expression of STAT6 protein. Acta Neuropathol. 2013; 125; 651–658.
- 40Doyle LA, Vivero M, Fletcher CD, Mertens F, Hornick JL. Nuclear expression of STAT6 distinguishes solitary fibrous tumour from histologic mimics. Mod. Pathol. 2013; (in press).
- 41Antonescu CR, Dal Cin P, Nafa K et al. EWSR1–CREB1 is the predominant gene fusion in angiomatoid fibrous histiocytoma. Genes Chromosom. Cancer 2007; 46; 1051–1060.
- 42Rossi S, Szuhai K, Ijszenga M et al. EWSR1–CREB1 and EWSR1–ATF1 fusion genes in angiomatoid fibrous histiocytoma. Clin. Cancer Res. 2007; 13; 7322–7328.
- 43Mertens F, Fletcher CD, Antonescu CR et al. Clinicopathologic and molecular genetic characterization of low-grade fibromyxoid sarcoma and cloning of a novel FUS/CREB3L1 fusion gene. Lab. Invest. 2005; 85; 408–415.
- 44Antonescu CR, Zhang L, Chang NE et al. EWSR1–POU5F1 fusion in soft tissue myoepithelial tumours. A molecular analysis of sixty-six cases, including soft tissue, bone and visceral lesions, showing common involvement of the EWSR1 gene. Genes Chromosom. Cancer 2010; 49; 1114–1124.
- 45Errani C, Zhang L, Sung YS et al. A novel WWTR1–CAMTA1 gene fusion is a consistent abnormality in epithelioid hemangioendothelioma of different anatomic sites. Genes Chromosom. Cancer 2011; 50; 644–653.
- 46Tanas MR, Sboner A, Oliveira AM et al. Identification of a disease-defining gene fusion in epithelioid hemangioendothelioma. Sci. Transl. Med. 2011; 3; 98ra82.
- 47Wang L, Motoi T, Khanin R et al. Identification of a novel, recurrent HEY1–NCOA2 fusion in mesenchymal chondrosarcoma based on a genome-wide screen of exon-level expression data. Genes Chromosom. Cancer 2012; 51; 127–139.
- 48Gebre-Medhin S, Nord KH, Möller E et al. Recurrent rearrangement of the PHF1 gene in ossifying fibromyxoid tumours. Am. J. Pathol. 2012; 181; 1069–1077.
- 49Pan CC, Chung MY, Ng KF et al. Constant allelic alteration on chromosome 16p (TSC2 gene) in perivascular epithelioid cell tumour (PEComa): genetic evidence for the relationship of PEComa with angiomyolipoma. J. Pathol. 2008; 214; 387–393.
- 50Folpe AL, Kwiatkowski DJ. Perivascular epithelioid cell neoplasms: pathology and pathogenesis. Hum. Pathol. 2010; 41; 1–15.
- 51Argani P, Aulmann S, Illei PB et al. A distinctive subset of PEComas harbors TFE3 gene fusions. Am. J. Surg. Pathol. 2010; 34; 1395–1406.
- 52Malinowska I, Kwiatkowski DJ, Weiss S. Perivascular epithelioid cell tumours (PEComas) harboring TFE3 gene rearrangements lack the TSC2 alterations characteristic of conventional PEComas: further evidence for a biological distinction. Am. J. Surg. Pathol. 2012; 36; 783–784.
- 53Antonescu CR, Yoshida A, Guo T et al. KDR activating mutations in human angiosarcomas are sensitive to specific kinase inhibitors. Cancer Res. 2009; 69; 7175–7179.
- 54Manner J, Radlwimmer B, Hohenberger P et al. MYC high level gene amplification is a distinctive feature of angiosarcomas after irradiation or chronic lymphedema. Am. J. Pathol. 2010; 176; 34–39.
- 55Guo T, Zhang L, Chang NE. Consistent MYC and FLT4 gene amplification in radiation-induced angiosarcoma but not in other radiation-associated atypical vascular lesions. Genes Chromosom. Cancer 2011; 50; 25–33.
- 56Italiano A, Thomas R, Breen M et al. The miR-17-92 cluster and its target THBS1 are differentially expressed in angiosarcomas dependent on MYC amplification. Genes Chromosom. Cancer 2012; 51; 569–578.