Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong.
Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Genes Chromosomes Cancer. 2024 Mar;63(3):e23227. doi: 10.1002/gcc.23227.
AIMS: Kinase fusion-positive soft tissue tumors represent an emerging, molecularly defined group of mesenchymal tumors with a wide morphologic spectrum and diverse activating kinases. Here, we present two cases of soft tissue tumors with novel LTK fusions. METHODS AND RESULTS: Both cases presented as acral skin nodules (big toe and middle finger) in pediatric patients (17-year-old girl and 2-year-old boy). The tumors measured 2 and 3 cm in greatest dimension. Histologically, both cases exhibited bland-looking spindle cells infiltrating adipose tissue and accompanied by collagenous stroma. One case additionally displayed perivascular hyalinization and band-like stromal collagen. Both cases exhibited focal S100 staining, and one case had patchy coexpression of CD34. Targeted RNA-seq revealed the presence of novel in-frame MYH9::LTK and MYH10::LTK fusions, resulting in upregulation of LTK expression. Of interest, DNA methylation-based unsupervised clustering analysis in one case showed that the tumor clustered with dermatofibrosarcoma protuberans (DFSP). One tumor was excised with amputation with no local recurrence or distant metastasis at 18-month follow-up. The other case was initially marginally excised with local recurrence after one year, followed by wide local excision, with no evidence of disease at 10 years of follow-up. CONCLUSIONS: This is the first reported case series of soft tissue tumors harboring LTK fusion, expanding the molecular landscape of soft tissue tumors driven by activating kinase fusions. Furthermore, studies involving a larger number of cases and integrated genomic analyses will be warranted to fully elucidate the pathogenesis and classification of these tumors.
目的:激酶融合阳性的软组织肿瘤代表了一组新兴的、分子定义明确的间叶性肿瘤,具有广泛的形态学谱和不同的激活激酶。在这里,我们报告了两例具有新型 LTK 融合的软组织肿瘤。
方法和结果:两例均为儿童患者(17 岁女孩和 2 岁男孩)四肢皮肤结节(大脚趾和中指)。肿瘤最大径为 2cm 和 3cm。组织学上,两例均表现为良性梭形细胞浸润脂肪组织,并伴有胶原基质。一例还显示血管周围玻璃样变和带状间质胶原。两例均有局灶性 S100 染色,一例有 CD34 斑片状共表达。靶向 RNA-seq 显示存在新型框内 MYH9::LTK 和 MYH10::LTK 融合,导致 LTK 表达上调。有趣的是,一例肿瘤的基于 DNA 甲基化的无监督聚类分析显示,该肿瘤与隆突性皮肤纤维肉瘤(DFSP)聚类。一例肿瘤行截肢切除,18 个月随访无局部复发或远处转移。另一例最初行边缘切除,一年后局部复发,随后行广泛局部切除,10 年随访无疾病证据。
结论:这是首例报道的 LTK 融合软组织肿瘤病例系列,扩大了由激活激酶融合驱动的软组织肿瘤的分子图谱。此外,需要进行更多病例的研究和综合基因组分析,以充分阐明这些肿瘤的发病机制和分类。
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