1. RREB1-MKL2 fusion in biphenotypic 'oropharyngeal' sarcoma: New entity or part of the spectrum of biphenotypic sinonasal sarcomas?
- Author
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Philippe Rochaix, Aurore Siegfried, David Grand, Frédéric Escudié, Claire Romary, Yvan Nicaise, Christine Chevreau, Emmanuelle Uro-Coste, Sophie Le Guellec, Sébastien Vergez, Jean-Michel Coindre, and Béatrice Herbault Barres
- Subjects
Male ,0301 basic medicine ,Cancer Research ,Oncogene Proteins, Fusion ,PAX3 ,Soft Tissue Neoplasms ,Biology ,medicine.disease_cause ,S100 protein ,Fusion gene ,03 medical and health sciences ,0302 clinical medicine ,Biomarkers, Tumor ,Genetics ,medicine ,Humans ,Oncogene Fusion ,Gene ,Transcription factor ,Sarcoma ,Middle Aged ,medicine.disease ,DNA-Binding Proteins ,Oropharyngeal Neoplasms ,030104 developmental biology ,030220 oncology & carcinogenesis ,Cancer research ,Spindle cell sarcoma ,Gene Fusion ,Carcinogenesis ,Paranasal Sinus Neoplasms ,Transcription Factors - Abstract
An increasing number of sarcomas displaying a primitive, monomorphic spindle cell phenotype have been shown to harbor recurrent gene fusions, including biphenotypic sinonasal sarcoma (SNS). Occurring in the sinonasal area of middle-aged patients, SNS is a locally aggressive tumor harboring in 90% of cases recurrent gene fusions involving the PAX3 gene, in which the chimeric transcription factor induces an aberrant dual myogenic and neural phenotype. Here, we report an unusual oropharyngeal monomorphic spindle cell sarcoma in a 53-year-old man that revealed a novel RREB1-MKL2 gene fusion by RNA sequencing with the Illumina TruSight RNA Fusion Panel. The gene fusion was validated by RT-PCR. Although the tumor location is unusual (but head and neck seated), most of the other clinical, morphologic, immunophenotypic (focal combined expression of S100 protein, SMA, desmin, and myogenin) and oncogenic data suggest that this biphenotypic "oropharyngeal" sarcoma is closely related to the biphenotypic SNS spectrum. Notably, the RREB1-MKL2 chimeric transcription factor encoded by this fusion gene produced an increase in MKL2 expression, which regulates both neural and myogenic differentiation, mimicking the crucial role of PAX3 reported in SNS oncogenesis. NGS and especially RNA sequencing may be used to identify new candidate fusion oncogenes in soft tissue tumors, which would help in updating the existing classification. In turn, this would lead to better therapeutic management of patients.
- Published
- 2018