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[软骨肿瘤:形态学、遗传学及靶向治疗的现状]

[Cartilage tumors: morphology, genetics, and current aspects of target therapy].

作者信息

Roessner Albert, Smolle Maria, Schoeder Victor, Haybaeck Johannes

机构信息

Institut für Pathologie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.

Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich.

出版信息

Pathologe. 2020 Mar;41(2):143-152. doi: 10.1007/s00292-020-00752-5.

DOI:10.1007/s00292-020-00752-5
PMID:32060685
Abstract

Cartilage tumors are a heterogeneous group of mesenchymal tumors whose common characteristic is the formation of a chondroblastic differentiated groundsubstance by the tumor cells. The basic features of their histological classification were already developed in the 1940s and supplemented by further entities in the following decades. Only in the past 10-15 years have fundamental new insights been gained through molecular genetic analysis. So, osteochondromas are characterized by alterations in the EXT1 and EXT2 genes. The description of mutations of isocitrate dehydrogenase 1 and 2 (IDH 1 and 2) in chondromas and chondrosarcomas is particularly important. The mesenchymal chondrosarcoma is characterized by a fusion of the HEY1-NCOA2 genes. The molecular genetic alterations characteristic for the individual tumor entities are first of all an essential supplement for the differential diagnosis of radiologically and histologically difficult cases. They also provide the basis for the establishment of molecular target therapies for malignant chondrogenic tumors. This applies in particular to conventional chondrosarcoma, for which all approaches to chemo- and radiotherapy have proven to be ineffective. However, the use of target therapies is still in its beginnings.

摘要

软骨肿瘤是一组异质性间充质肿瘤,其共同特征是肿瘤细胞形成软骨母细胞分化的基质。其组织学分类的基本特征在20世纪40年代就已形成,并在随后几十年中增加了更多类型。仅在过去10至15年中,通过分子遗传学分析才获得了根本性的新见解。例如,骨软骨瘤的特征是EXT1和EXT2基因发生改变。软骨瘤和软骨肉瘤中异柠檬酸脱氢酶1和2(IDH 1和2)突变的描述尤为重要。间叶性软骨肉瘤的特征是HEY1-NCOA2基因融合。各个肿瘤实体特有的分子遗传学改变首先是对放射学和组织学诊断困难病例进行鉴别诊断的重要补充。它们也为恶性软骨源性肿瘤分子靶向治疗的建立提供了基础。这尤其适用于传统型软骨肉瘤,所有化疗和放疗方法对其均已证明无效。然而,靶向治疗的应用仍处于起步阶段。

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本文引用的文献

1
Conventional chondrosarcoma with focal clear cell change: a clinicopathological and molecular analysis.常规型软骨肉瘤伴局灶性透明细胞改变:临床病理及分子分析。
Histopathology. 2019 Dec;75(6):843-852. doi: 10.1111/his.13952. Epub 2019 Sep 13.
2
An update of molecular pathology of bone tumors. Lessons learned from investigating samples by next generation sequencing.骨肿瘤分子病理学的最新进展。从下一代测序研究样本中获得的经验教训。
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H3K27me3 deficiency defines a subset of dedifferentiated chondrosarcomas with characteristic clinicopathological features.
H3K27me3 缺失定义了具有特征性临床病理特征的去分化软骨肉瘤亚群。
Mod Pathol. 2019 Mar;32(3):435-445. doi: 10.1038/s41379-018-0140-5. Epub 2018 Oct 5.
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Integrating Morphology and Genetics in the Diagnosis of Cartilage Tumors.整合形态学与遗传学用于软骨肿瘤的诊断
Surg Pathol Clin. 2017 Sep;10(3):537-552. doi: 10.1016/j.path.2017.04.005.
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Diagnostic utility of IDH1/2 mutations to distinguish dedifferentiated chondrosarcoma from undifferentiated pleomorphic sarcoma of bone.异柠檬酸脱氢酶1/2(IDH1/2)突变在鉴别去分化软骨肉瘤与骨未分化多形性肉瘤中的诊断效用
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Hereditary Multiple Exostoses: New Insights into Pathogenesis, Clinical Complications, and Potential Treatments.遗传性多发性骨软骨瘤:发病机制、临床并发症及潜在治疗方法的新见解
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IDH1 and IDH2 mutations as novel therapeutic targets: current perspectives.异柠檬酸脱氢酶1和2突变作为新型治疗靶点:当前观点
J Blood Med. 2016 Sep 2;7:171-80. doi: 10.2147/JBM.S70716. eCollection 2016.
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Analysis of PD-L1, T-cell infiltrate and HLA expression in chondrosarcoma indicates potential for response to immunotherapy specifically in the dedifferentiated subtype.软骨肉瘤中PD-L1、T细胞浸润和HLA表达的分析表明,特别是去分化亚型对免疫疗法有潜在反应。
Mod Pathol. 2016 Sep;29(9):1028-37. doi: 10.1038/modpathol.2016.108. Epub 2016 Jun 17.
10
Targeted next-generation sequencing of dedifferentiated chondrosarcoma in the skull base reveals combined TP53 and PTEN mutations with increased proliferation index, an implication for pathogenesis.对头颈部去分化软骨肉瘤进行靶向二代测序显示,TP53和PTEN基因存在联合突变,增殖指数增加,这对发病机制具有重要意义。
Oncotarget. 2016 Jul 12;7(28):43557-43569. doi: 10.18632/oncotarget.9618.