When molecular outsmarts morphology: Malignant ossifying fibromyxoid tumors masquerading as osteosarcomas, including a novel CREBZF::PHF1 fusion Journal Article
| Authors: | Sharma, A. E.; Dermawan, J. K.; Sherrod, A. E.; Chopra, S.; Maki, R. G.; Antonescu, C. R. |
| Article Title: | When molecular outsmarts morphology: Malignant ossifying fibromyxoid tumors masquerading as osteosarcomas, including a novel CREBZF::PHF1 fusion |
| Abstract: | We present two cases of malignant ossifying fibromyxoid tumor (OFMT) which eluded diagnosis due to compelling clinicopathologic mimicry, compounded by similarly elusive underlying molecular drivers. The first is of a clavicle mass in a 69 year-old female, which histologically showed an infiltrative nested and trabeculated proliferation of monomorphic cells giving rise to scattered spicules of immature woven bone. Excepting SATB2 positivity, the lesion showed an inconclusive immunoprofile which along with negative PHF1 FISH led to an initial diagnosis of high-grade osteosarcoma. Next generation sequencing (NGS) revealed a particularly rare CREBBP::BCORL1 fusion. The second illustrates the peculiar presentation of a dural-based mass in a 52 year-old female who presented with neurologic dyscrasias. Sections showed a sheeted monotonous proliferation of ovoid to spindle cells, but in contrast to Case #1, the tumor contained an exuberance of reticular osteoid and woven bone deposition mimicking malignant osteogenic differentiation. NGS showed a novel CREBZF::PHF1 fusion. Both tumors recurred locally less than 1 year post-operatively. As such we reiterate that careful morphologic examination is axiomatic to any diagnosis in our discipline, but this paradigm must shift to recognize that molecular diagnostics can provide closure where traditional tools have notable limitations. © 2023 Wiley Periodicals LLC. |
| Keywords: | immunohistochemistry; osteosarcoma; adult; clinical article; human tissue; aged; bone neoplasms; middle aged; bone tumor; dna binding protein; genetics; dna-binding proteins; paresthesia; cancer recurrence; case report; postoperative period; cancer grading; neoplasm recurrence, local; differential diagnosis; pathology; sarcoma; fluorescence in situ hybridization; tumor recurrence; gene fusion; fusion gene; fibroma; brain cancer; craniotomy; bone development; osteogenesis; biopsy technique; basic leucine zipper transcription factor; basic-leucine zipper transcription factors; treatment refusal; soft tissue neoplasms; soft tissue tumor; polycomb group protein; fusion; synaptophysin; clavicle; surgical margin; perception deafness; consciousness disorder; phf1 protein, human; myosin heavy chain; ossifying fibroma; high throughput sequencing; bcor; humans; human; female; article; polycomb-group proteins; phf1; bcorl1; ossifying fibromyxoid tumor; fibroma, ossifying; crebbp1; crebzf1; malignant ossifying fibromyxoid tumor; crebzf protein, human; crebzf gene; phf1 gene |
| Journal Title: | Genes Chromosomes and Cancer |
| Volume: | 63 |
| Issue: | 1 |
| ISSN: | 1045-2257 |
| Publisher: | Wiley Periodicals, Inc |
| Date Published: | 2024-01-01 |
| Start Page: | e23206 |
| Language: | English |
| DOI: | 10.1002/gcc.23206 |
| PUBMED: | 37819540 |
| PROVIDER: | scopus |
| PMCID: | PMC11370659 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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