Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient
Background. Angiomatoid fibrous histiocytoma (AFH) is a rare intermediate malignant tumor that arises mainly in soft tissues, especially in the superficial extremities of patients younger than 30 years. There have been a few reports of AFH arising from sites other than soft tissue, including bone, a...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2021/9434222 |
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| author | Hiroshi Kobayashi Naohiro Makise Aya Shinozaki-Ushiku Yuki Ishibashi Masachika Ikegami Shinji Kohsaka Tetsuo Ushiku Katsutoshi Oda Kiyoshi Miyagawa Hiroyuki Aburatani Hiroyuki Mano Sakae Tanaka |
| author_facet | Hiroshi Kobayashi Naohiro Makise Aya Shinozaki-Ushiku Yuki Ishibashi Masachika Ikegami Shinji Kohsaka Tetsuo Ushiku Katsutoshi Oda Kiyoshi Miyagawa Hiroyuki Aburatani Hiroyuki Mano Sakae Tanaka |
| author_sort | Hiroshi Kobayashi |
| collection | DOAJ |
| description | Background. Angiomatoid fibrous histiocytoma (AFH) is a rare intermediate malignant tumor that arises mainly in soft tissues, especially in the superficial extremities of patients younger than 30 years. There have been a few reports of AFH arising from sites other than soft tissue, including bone, and unusual site and age make it difficult to diagnose this rare tumor. Case Presentation. Here, we present a case of a 54-year-old man who was examined for chest pain, and computed tomography (CT) incidentally detected a bone tumor at the scapula with destruction of cortical bone and invasion into soft tissue. Magnetic resonance imaging revealed multiple cystic components with fluid-fluid levels. FDG-PET showed uptake at the axillary lymph node. The CT-guided needle biopsy revealed spindle cell sarcoma on histopathology. After neoadjuvant chemotherapy, a scapulectomy was performed. The final postresection histopathological diagnosis was the same as the preoperative diagnosis, and no obvious chemotherapeutic effect was observed. Next-generation sequencing of RNA isolated from paraffin-embedded tumor tissue revealed that these lesions harbored the EWSR1-CREB1 fusion gene, and the tumor was diagnosed as AFH. C-reactive protein level, which was elevated preoperatively, decreased after the operation, and there was no recurrence or metastasis 5 years after the treatment. Conclusion. The diagnosis of AFH is difficult when the tumor has an atypical presentation. Comprehensive genomic analysis, especially RNA sequencing, is efficient in diagnosing this rare tumor. Moreover, magnetic resonance imaging findings identical to AFH in soft tissue, the presence of paraneoplastic symptoms such as elevated inflammatory markers, and lymph node swelling were clues towards suspecting this tumor. |
| format | Article |
| id | doaj-art-f575e7a1ea3848f6a046e2b632a877d0 |
| institution | Kabale University |
| issn | 2090-6749 2090-6757 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Orthopedics |
| spelling | doaj-art-f575e7a1ea3848f6a046e2b632a877d02025-02-03T01:27:02ZengWileyCase Reports in Orthopedics2090-67492090-67572021-01-01202110.1155/2021/94342229434222Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult PatientHiroshi Kobayashi0Naohiro Makise1Aya Shinozaki-Ushiku2Yuki Ishibashi3Masachika Ikegami4Shinji Kohsaka5Tetsuo Ushiku6Katsutoshi Oda7Kiyoshi Miyagawa8Hiroyuki Aburatani9Hiroyuki Mano10Sakae Tanaka11Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDivision of Cellular Signaling, National Cancer Center Research Institute, Tokyo, JapanDepartment of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDivision of Integrative Genomics, The University of Tokyo, Tokyo, JapanLaboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo, Tokyo, JapanGenome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, JapanDivision of Cellular Signaling, National Cancer Center Research Institute, Tokyo, JapanDepartment of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanBackground. Angiomatoid fibrous histiocytoma (AFH) is a rare intermediate malignant tumor that arises mainly in soft tissues, especially in the superficial extremities of patients younger than 30 years. There have been a few reports of AFH arising from sites other than soft tissue, including bone, and unusual site and age make it difficult to diagnose this rare tumor. Case Presentation. Here, we present a case of a 54-year-old man who was examined for chest pain, and computed tomography (CT) incidentally detected a bone tumor at the scapula with destruction of cortical bone and invasion into soft tissue. Magnetic resonance imaging revealed multiple cystic components with fluid-fluid levels. FDG-PET showed uptake at the axillary lymph node. The CT-guided needle biopsy revealed spindle cell sarcoma on histopathology. After neoadjuvant chemotherapy, a scapulectomy was performed. The final postresection histopathological diagnosis was the same as the preoperative diagnosis, and no obvious chemotherapeutic effect was observed. Next-generation sequencing of RNA isolated from paraffin-embedded tumor tissue revealed that these lesions harbored the EWSR1-CREB1 fusion gene, and the tumor was diagnosed as AFH. C-reactive protein level, which was elevated preoperatively, decreased after the operation, and there was no recurrence or metastasis 5 years after the treatment. Conclusion. The diagnosis of AFH is difficult when the tumor has an atypical presentation. Comprehensive genomic analysis, especially RNA sequencing, is efficient in diagnosing this rare tumor. Moreover, magnetic resonance imaging findings identical to AFH in soft tissue, the presence of paraneoplastic symptoms such as elevated inflammatory markers, and lymph node swelling were clues towards suspecting this tumor.http://dx.doi.org/10.1155/2021/9434222 |
| spellingShingle | Hiroshi Kobayashi Naohiro Makise Aya Shinozaki-Ushiku Yuki Ishibashi Masachika Ikegami Shinji Kohsaka Tetsuo Ushiku Katsutoshi Oda Kiyoshi Miyagawa Hiroyuki Aburatani Hiroyuki Mano Sakae Tanaka Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient Case Reports in Orthopedics |
| title | Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient |
| title_full | Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient |
| title_fullStr | Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient |
| title_full_unstemmed | Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient |
| title_short | Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient |
| title_sort | scapular angiomatoid fibrous histiocytoma with ewsr1 creb1 fusion in an adult patient |
| url | http://dx.doi.org/10.1155/2021/9434222 |
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