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Epithelioid and spindle cell rhabdomyosarcoma with FUS-TFCP2 or EWSR1-TFCP2 fusion: report of two cases

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Abstract

The WHO Classification of Tumors of Soft Tissue and Bone divides rhabdomyosarcoma (RMS) into alveolar, embryonal, pleomorphic, and spindle cell/sclerosing types. Advances in molecular diagnostics have allowed for further refinement of RMS classification including the identification of new subtypes. Very rare RMS with epithelioid and spindle cell morphology, female predominance, marked osseous predilection, ALK expression, EWSR1/FUS-TFCP2 gene fusions, and highly aggressive clinical behavior have recently been recognized with only 23 cases reported in the English language literature. Herein, we report two additional cases with detailed clinicopathologic description and molecular confirmation. In brief, two young women presented each with a primary bone tumor—one with a frontal bone tumor and another with an osseous pelvic tumor. Both tumors showed epithelioid to spindle cell morphology, ALK expression, and EWSR1/FUS-TFCP2 gene fusions. Both patients died of disease less than 17 months from diagnosis despite administration of multiple lines of aggressive treatment. In addition, we review the literature and discuss differential diagnostic and potential treatment considerations.

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Authors and Affiliations

  1. Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA

    John S.A. Chrisinger

  2. Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, ON, Canada

    Bret Wehrli

  3. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Brendan C. Dickson & Elizabeth G. Demicco

  4. Princess Margaret Cancer Centre, Division of Medical Oncology, University of Toronto, Toronto, ON, Canada

    Samir Fasih & Abha A. Gupta

  5. Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Angela C. Hirbe

  6. Department of Radiation Oncology, Princess Margaret Cancer Centre & Department of Radiation Oncology, University of Toronto, Toronto, Canada

    David B. Shultz

  7. Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Gelareh Zadeh

  8. MacFeeters-Hamilton Center for Neuro-Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada

    Gelareh Zadeh

  9. Division of Haematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Abha A. Gupta

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  1. John S.A. Chrisinger
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Contributions

John Chrisinger: Project planning, slide review, data gathering, data analysis, literature review, and manuscript writing

Bret Wehrli: Data gathering, data analysis, and manuscript writing

Brendan Dickson: Data analysis, next generation sequencing, and manuscript writing

Samir Fasih: Data gathering, data analysis, and manuscript writing

Angela Hirbe: Data gathering, data analysis, and manuscript writing

David Shultz: Data gathering, data analysis, and manuscript writing

Gelareh Zadeh: Data gathering, data analysis, and manuscript writing

Abha Gupta: Data gathering, data analysis, and manuscript writing

Elizabeth Demicco: Project planning, slide review, data gathering, data analysis, literature review, and manuscript writing

Corresponding author

Correspondence to John S.A. Chrisinger.

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The study was approved by the Institutional Review Boards of Washington University School of Medicine and Mount Sinai Hospital.

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Chrisinger, J.S., Wehrli, B., Dickson, B.C. et al. Epithelioid and spindle cell rhabdomyosarcoma with FUS-TFCP2 or EWSR1-TFCP2 fusion: report of two cases. Virchows Arch 477, 725–732 (2020). https://doi.org/10.1007/s00428-020-02870-0

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