EWSR1 阴性未分化小圆蓝细胞肉瘤中高频出现 CIC 融合与双同源盒(DUX4)转录因子。

High prevalence of CIC fusion with double-homeobox (DUX4) transcription factors in EWSR1-negative undifferentiated small blue round cell sarcomas.

机构信息

Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

出版信息

Genes Chromosomes Cancer. 2012 Mar;51(3):207-18. doi: 10.1002/gcc.20945. Epub 2011 Nov 10.

Abstract

Primitive round cell sarcomas of childhood and young adults have been problematic to diagnose and classify. Our goal was to investigate the pathologic and molecular characteristics of small blue round cell tumors (SBRCT) that remained unclassified after exhaustive immunohistochemistry and molecular screening to exclude known sarcoma-related translocations. As rare examples of EWSR1-negative SBRCT have been shown to carry rearrangements for FUS and CIC genes, we undertook a systematic screening for these two genes. CIC rearrangements by FISH were detected in 15/22 (68%), while none showed FUS abnormalities. RACE, RT-PCR, and/or long-range DNA PCR performed in two cases with frozen material showed that CIC was fused to copies of the DUX4 gene on either 4q35 or 10q26.3. Subsequent FISH analysis confirmed fused signals of CIC with either 4q35 or 10q26.3 region in six cases each. Tumors positive for CIC-DUX4 fusion occurred mainly in male young adult patients (median age: 29 years), with the extremities being the most frequent location. Microscopically, tumors displayed a primitive, round to oval cell morphology with prominent nucleoli, high mitotic count, and areas of necrosis. O13 expression was variable, being either diffuse or patchy and tumors mostly lacked other markers of differentiation. Although CIC-DUX4 resulting in a t(4;19) translocation has been previously described in primitive sarcomas, this is the first report implicating the related DUX4 on 10q26 in oncogenesis. These results suggest the possibility of a newly defined subgroup of primitive round cell sarcomas characterized by CIC rearrangements, distinct from Ewing sarcoma family of tumors.

摘要

儿童和青年期原始小圆细胞肉瘤的诊断和分类一直存在问题。我们的目的是研究经过广泛的免疫组织化学和分子筛选排除已知肉瘤相关易位后仍未分类的小蓝圆形细胞肿瘤(SBRCT)的病理和分子特征。由于已经证明少数 EWSR1 阴性 SBRCT 携带 FUS 和 CIC 基因的重排,因此我们进行了这两个基因的系统筛查。通过 FISH 检测到 15/22(68%)例 CIC 重排,而无一例显示 FUS 异常。在两例冷冻标本中进行的 RACE、RT-PCR 和/或长距离 DNA PCR 显示 CIC 与 DUX4 基因的拷贝融合在 4q35 或 10q26.3 上。随后的 FISH 分析在 6 例中分别证实了 CIC 与 4q35 或 10q26.3 区域融合的信号。CIC-DUX4 融合阳性的肿瘤主要发生在男性青年患者(中位年龄:29 岁),最常见的部位是四肢。显微镜下,肿瘤表现为原始的、圆形到椭圆形细胞形态,核仁明显,有丝分裂计数高,并有坏死区。O13 表达不定,呈弥漫性或斑片状,肿瘤大多缺乏其他分化标志物。虽然 CIC-DUX4 导致的 t(4;19)易位已在原始肉瘤中被描述,但这是首次报道相关的 DUX4 位于 10q26 在肿瘤发生中的作用。这些结果表明,存在一种以 CIC 重排为特征的新定义的原始小圆细胞肉瘤亚组,与尤文肉瘤家族肿瘤不同。

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