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High-density microarrays are used to measure in a comprehensive manner large-scale ("profile") gene expression patterns (when tumor RNA is tested) or gene copy number changes (when tumor genomic DNA is tested). Microarray-based studies are increasingly useful in addressing a wide variety of questions in sarcoma biology. This review includes a brief description of the microarray methodology and data analysis, followed by few examples of the recent applications of gene expression in the diagnosis, classification, and treatment of sarcomas. [ABSTRACT FROM AUTHOR]

The term malignant fibrous histiocytoma was coined by Stout and associates in the 1960s to encompass pleomorphic soft tissue sarcomas presumably derived from histiocytes that are capable of fibroblastic transformation. The concept was reaffirmed in the following 2 decades and malignant fibrous histiocytoma thus was regarded as the most common soft tissue tumor in older adults. However, recent more critical clinicopathologic, ultrastructural, and immunohistochemical studies have shown that malignant fibrous histiocytomas are not derived from histiocytic "facultative fibroblasts" and many neoplasms so diagnosed actually are pleomorphic subtypes of other sarcomas. Meticulous electron microscopic and immunohistochemical investigations also found that the more common storiform-pleomorphic, myxoid, and perhaps the giant cell subtypes are composed of variable mixtures of fibroblasts and phenotypically modulated fibroblastic cells, notably myofibroblasts and histiofibroblasts. On the basis of these findings, we propose a new classification for the above subtypes of so called malignant fibrous histiocytoma, the majority of which are variants of pleomorphic fibrosarcoma. [ABSTRACT FROM AUTHOR]

Low-grade fibrosarcomas have recently gained increasing attention in the literature, especially with the fall in popularity polls of the ubiquitous malignant fibrous histiocytoma (MRH). Firstly, most tumors previously known as myxoid MFH are labeled presently as myxofibrosarcomas. Secondly, the recognition and better understanding of a family of fibrosing- type fibrosarcoma, encompassing 3 members: fibromyxoid sarcoma (FMS), hyalinizing spindle cell tumor with giant rosettes (HSTGR), and sclerosing epithelioid fibrosarcoma (SEF). To expand further their understanding of the overlapping arid distinct features of members included in the spectrum of low-grade fibrosarcoma. the authors carried out a comparative ultrastructural study among 15 low-grade myxofibrosarcomas (MFS) and 12 fibromyxoid sarcomas (FMS), after review of pathology and confirmation of diagnosis. The ultrastructural findings of the LG MFS identified spindle to plump cells, with abundant cytoplasm, rich in well-developed RER cisternae, often distended and sometimes cystically dilated, containing an electronlucent granular material. These results were in keeping with a well-differentiated fibroblastic-type cell phenotype. In addition, a less prominent cellular component included cells with RER, well-developed Golgi apparatus, lysosomes, and filopodia. These latter features define a fibroblastic variant with histiocytic like properties, also known as histiofibroblasts. Myofibroblastic differentiation was quite limited and mostly absent in most of the cases. in summary, these findings recapitulate a similar spectrum with the cell constituents of so-called MFH. In contrast, the fine microscopic findings of the 12 FMS cases showed an inactive or more primitive form of fibroblastic type cells, The RER cisternae were generally underdeveloped, as expected for a generic fibroblastic-type proliferation. The cytoplasm was scant and showed a paucity of organelIes, with the exception of abundant arrays of vimentin-type intermediate filaments. The very long, thin cell processes, sometimes associated with pinocytotic vesicles, were reminiscent of perineurioma ultrastructure. [ABSTRACT FROM AUTHOR]

A specific TLS-CHOP fusion gene derived from the t(12;16) is present in at least 95% of myxoid/round cell liposarcomas (MLS). Rare cases of MLS show a variant t(12;22) translocation, resulting in EWS-CHOP fusion gene. The CHOP gene encodes a leucine-zipper transcription factor, which is implicated in both oncogenic transformation and inhibition of adipogenesis To examine whether the molecular variability of TLS-CHOP or EWS-CHOP fusion transcript structure is associated with the degree of inhibition of adipogenesis, a comparative ultrastructural and RT-PCR-based analysis of 14 MLS was performed. The specimens consisted of 9 primary, 2 locally recurrent tumors, and one representative sample each from 3 patients with multifocal soft tissue metastases. Histologically, there were 8 high-grade and 6 low-grade MLS using 5% round cell (RC) component as the cutoff point. By RT-PCRassay there were 13 cases with TLS-CHOP fusion transcripts: 7 cases of type 5-2 (known as type II), 4 cases of type 7-2 (known as type I). 1 case of type 8-2 (known as type III), and 1 unique case of type 6-2. The remaining 1 case showed an EWS-CHOP fusion transcript. Ultrastructural examination revealed that tumor cells were composed of a moderate-to-predominant proportion of well-formed lipoblasts in 4 cases, while in 6 cases such lipoblasts were very scant, The remaining 4 tumors were arrested in the stage of transitional cells. The heterogeneity of TLS-CHOP fusion transcript showed no apparent impact on adipogenesis. since both TLS-CHOP type I and II cases could randomly display various levels of lipoblastic differentiation. Furthermore, the 4 cases without definite lipoblasts showed no preference for any specific fusion variants and consisted of one each of TLS-CHOP subtypes. In addition, the fusion transcript variants did not correlate with other Ultrastructural features, such as the presence and amount of glycogen, mitochondria, rough endoplasmic reticulum, vimentin-like intermediate filaments, and external lamina. However, there appeared to have a trend suggesting the predilections of glycogen particles and vimentin-like intermediate filaments in primitive mesenchymal cells and/or transitional cells. These findings cannot substantiate the hypothesis that the molecular variability of fusion transcripts has a biological impact on adipogenesis of MLS. and other factors might be implicated in their level of differentiation. [ABSTRACT FROM AUTHOR]

Pleomorphic liposarcoma (PL) is the least common subtype of liposarcoma, displaying a lipoblastic, malignant fibrous histiocytoma (MFH)-like and, less frequently, an epithelioid growth pattern. The epithelioid morphology in PL is still underrecognized and may closely simulate other epithelial neoplasms, mainly adrenal cortical carcinoma (ACC). No electron microscopic (EM) studies of the epithelioid variant of PL have been previously described, nor have there been studies of its immunoreactivity with A103 or α-inhibin. The purpose of this study is to analyze the histological, immunohistochemical, and EM features of epithelioid PL in an attempt to better explore the distinction from their epithelial mimickers, such as ACC. A panel of 5 antibodies was studied, including A103, α-inhibin, smooth muscle actin (SMA), AE1/AE3, and Cam 5.2. Out of 22 cases of PLs, 6 cases characterized by the presence of both epithelioid phenotype and pleomorphic lipoblasts were identified from the EM archives. There were 4 females and 2 males, with a mean age of 58 (range, 39-78). Two lesions arose in the thigh and 1 each in the abdominal wall, chest wall, anterior mediastinum, and retroperitoneum, with tumor size ranging from 7 to 17 cm (mean, 13 cm). Histologically, 2 PLs were pure epithelioid, whereas the other 4 had a mixed epithelioid and MFH-like appearance. Immunohistochemically, A103 (4/6), SMA (4/6), and AE1/AE3 (1/6) revealed a various degree of positive reactions. No immunolabeling for α-inhibin or Cam5.2 was detected in any case. By EM, the epithelioid areas revealed round or polyhedral cells with lipid droplets of various sizes and number, intimately apposed cell surfaces, occasional junction-like structures (4/6), and micropinocytotic vesicles (4/6). Interestingly, the ribosome-lamellar complexes, once thought to be characteristic of hairy cell leukemia but rarely seen in solid tumors, were noted in one pure epithelioid PL. When compared to the MFH-like area, rough endoplasmic reticula (RER) were less well developed, but mitochondria were more prominent in the epithelioid components. Neither mitochondria with tubulovesicular cristae nor prominent smooth endoplasmic reticula indicative of ACC were seen. Well-formed external lamina was not present. Other features to support a higher level of epithelial differentiation, such as lumen formation, microvilli, and tonofilaments, were not found. In conclusion, focal A103 reactivity in epithelioid undifferentiated tumors should be interpreted with caution before rendering the diagnosis of a primary or metastatic ACC, especially when examining biopsy specimens. The possibility of an epithelioid variant of PL must be excluded; α-inhibin can serve as a useful adjunct in this regard. In addition to variable intracytoplasmic fat droplets, the distinctive ultrastructural features of epithelioid variant of PL include numerous mitochondria, pinocytotic vesicles, junction-like structures, and, rarely, ribosome-lamellar complex. Despite some overlapping features, electron microscopy remains a useful tool to distinguish between epithelioid PL and ACC. [ABSTRACT FROM AUTHOR]

Because the fibroblast has a remarkable capability of phenotypic modulations, reflected in both morphologic and immunohistochemical (IHC) changes, ultrastructural studiesare mandatory to identify the variants of fibroblasts. Myofibroblasts or histiofibroblasts are such examples, demonstrating chimeric ultrastructural features of fibroblastic cells in common with smooth muscle cells or with histiocytes, respectively. The presence of epithelioid fibroblastic cells sharing morphologic features with epithelial or plasma cells has not been yet characterized. The authors identified 4 cases of fibrosarcomas (FS) characterized by an unusual phenotype and associated with peculiar ultrastructural findings. The electron microscopic (EM) findings were correlated with the histologic appearance and immunoprofile. All tumors were located in the extremities, 3 in soft tissues and 1 in the bone. By light microscopy 2 cases were composed predominantly by round uniform cells with a striking plasmacytoid appearance. One case mimicked carcinoma, composed predominantly by epithelioid cells and scattered giant tumor cells. The fourth case showed a mixture of plasmacytoid-like and epithelioid cells. By IHC, tumor cells were positive for vimentin and in 2 cases also for epithelial membrane antigen. Kappa/lambda light chain and cytokeratins markers were negative. By EM all 4 tumors showed in addition to classic features of fibroblasts, unusual epithelial-type features, such as secretory granules of "neurosecretory-type" (3 cases), rudimentary cell junctions (3 cases), microvilli (2 cases), and lumen-like structures (1 case). One plasmacytoid-type tumor showed finely granular extracellular deposits. The study describe 4 examples of fibrosarcomas with unusual features at the ultrastructural level, which are associated microscopically with a peculiar phenotype, mimicking plasmacytoma or carcinoma. These findings broaden the spectrum of fibroblastic cell variants in neoplasia. [ABSTRACT FROM AUTHOR]

As primary bone fibrosarcoma (FS) and malignant fibrous histiocytoma (MFH) have similar clinical, radiographic, or survival manifestations, ultrastructural and immunohistochemical studies were undertaken to determine the differentiation pathways of constituent malignant cells. Twelve cases of primary intraosseous FS and MFH were selected for this ultrastructural comparative study and were analyzed for fibroblastic or modified fibroblastic differentiation. There were 4 FS cases and 8 MFH cases, of which 5 were storiform-pleomorphic, 2 were giant cell, and 1 was myxoid type. All FS consisted of spindle fibroblasts with a prominent rough endoplasmic reticulum and Golgi apparatus, variable amounts of vimentin intermediate filaments, and extracellular collagen fibrils. The MFH were composed of a mixture of spindle and pleomorphic fibroblasts (8/8), histiofibroblasts (4/8), and myofibroblasts (3/8). Variable numbers of undifferentiated cells were found in both tumors. In conclusion, fibroblastic differentiation and collagen production was noted in all cases. The often pleomorphic histiofibroblasts present in some MFH cases most likely represent "modified fibroblasts," similar to myofibroblasts. These findings support the hypothesis that the fibroblast and its variants are the predominant cell types found in these tumors, suggesting that the diagnostic entity MFH should be classified as a pleomorphic fibrosarcoma. [ABSTRACT FROM AUTHOR]

Hepatic embryonal (undifferentiated) sarcoma (ES) is a rare pediatric tumor occurring predominantly in the first decade of life, but a few examples of adult ES have also been described. Isolated ultrastructural reports describe contradictory lines of differentiation in these tumors. Four pediatric and 3 adult ES cases were studied ultrastructurally and features were correlated with morphology. Morphologically, tumors were composed of mixture of plump spindle cells and bizarre giant cells, showing abundant cytoplasmic eosinophilic globules. Ultrastructurally, the hallmark features in all cases included dilated RERs and secondary lysosomes with dense precipitates. Dilated mitochondria and mitochondrial–RER complexes were often seen. Other features included intracytoplasmic fat droplets, scant actin microfilaments, and focal glycogen pools. In summary, pediatric and adult ES show similar morphologic and ultrastructural features. Ultrastructurally, hepatic ES have distinctive findings, including dilated RER and electron-dense lysosomal precipitates, which correlate with the eosinophilic hyaline bodies seen microscopically. These findings suggest that ES are composed of fibroblastic, fibrohistiocytic, and undifferentiated cells. Other lines of differentiation were not identified. [ABSTRACT FROM AUTHOR]

Since 1980 when Sibley and coworkers first described a nodal neoplasm of unknown histogenesis with striking surface microvilli for which they introduced the term "anemone cell," a series of reports have appeared in the literature illustrating tumors with similar ultrastructural features. While most reported cases showed differentiation along a particular line, rare cases remained histogenetically unclear. In this report a case is described of epithelioid gastric gastrointestinal stromal tumor metastatic to the liver, showing conspicuous long microvillus-type cell processes partially or circumferentially coating the cell surfaces, thus qualifying as yet another tumor type with anemone cell features. [ABSTRACT FROM AUTHOR]

Dentofacial developmental abnormalities have been reported in head and neck rhabdomyosarcoma (HNRMS) patients treated with conventional radiotherapy technique and chemotherapy. This current study investigates dentofacial long-term effects among HNRMS survivors managed with intensity-modulated radiotherapy (IMRT) and chemotherapy. In general, IMRT is a more effective 3D-conformal radiotherapy technique, which delivers high doses of radiation to the tumor target while minimizing doses received by the surrounding normal tissues. The medical records and radiographs of thirteen patients were reviewed to identify the following: 1. Facial asymmetry and jaw hypoplasia. 2. Effects on the dental tissue causing tooth agenesis/hypodontia, root agenesis/stunting/malformation, and/or enamel hypoplasia. 3. Trismus, hyposalivation/xerostomia. Seven patients presented with facial asymmetry and jaw hypoplasia, 9 patients presented with effects on the dental tissue [root agenesis/stunting/malformation (9), tooth agenesis/hypodontia (7) and enamel hypoplasia (3)] and 7 patients developed trismus and /or xerostomia. All patients with facial asymmetry and jaw hypoplasia also developed dental abnormalities. Patients with dentofacial developmental abnormalities were ≤7 years of age at treatment. Our study shows that dentofacial developmental abnormalities are still a burden in the era of IMRT and as prognosis of childhood malignancy improves and more patients survive, these late dentofacial sequelae among childhood cancer survivors will become more common. Dental oncologists should be integral members in the management of children with head and neck cancers. [ABSTRACT FROM PUBLISHER]

GISTs are the most common mesenchymal neoplasms of the digestive tract and are thought to originate from or differentiate toward the interstitial cell of Cajal lineage. Almost all GISTs express KIT protein and the majority show activating mutations in either KIT or PDGFRA proto-oncogenes. Ultrastructurally, these tumors have been shown to have either a smooth muscle, neuronal, dual, or null phenotype. The objective of this study was to investigate the relationship between ultrastructural features and genotype in a large series of 125 histologically confirmed and CD117 positive GISTs. PCR analysis for the presence of KIT exon 9, 11, 13, and 17 and PDGFRA exon 12 and 18 mutations was performed. There were 62 (50%) tumors located in the stomach and 45 (36%) in the small bowel. Overall, KIT mutations were detected in 93 (75%) patients: 86 (69%) in exon 11, and 7 (6%) in exon 9. A PDGFRA mutation was detected in 7 (6%) cases and 25 (19%) cases had no mutation. Ultrastructurally, skeinoid fibers were seen in 55 (44%) cases and were more common in small bowel than stomach GISTs, and occurred in only in 1 of 16 patients with an ITD (KIT) exon 11 or PDGFRA mutation. Focal actin microfilaments were identified in 82 (65%) cases and did not correlate with location or mutation type. Rare neurosecretory-type granules (NS-G) were seen in 34 (27%) of cases, but were seen in most of the cells in only 5 (4%) cases. GISTs showing both NS-G and microtubules were associated with KIT exon 11 genotype and spindle cell morphology. PDGFRA mutated cases were associated with gastric location, predominantly epithelioid morphology and lacked NS-G. [ABSTRACT FROM AUTHOR]