Vol 14, No 6 (2018)
Review paper
Published online: 2019-03-15
Clear cell sarcoma
Oncol Clin Pract 2018;14(6):354-363.
Abstract
Clear cell sarcoma (CCS), also referred as to melanoma of soft tissues, is a rare malignant tumour of soft tissues. This tumour harbors the characteristic features of soft tissue sarcoma (STS) and is a slowly growing, painless tumour, which then acquires an aggressive course. CCS is characterized by a translocation t(12; 22)(q13; q12), which in addition to the diagnostic implications may be important for targeted treatment in the future. CCS occurs mainly on the limbs, most often shin (in feet and ankle area) in the tendons and aponeurosis, often at a young age. CCS is characterized by high potential to develop metastases in regional lymph nodes (about 30% of cases). In the diagnostic process one should consider performing a sentinel node biopsy with possible subsequent radical lymphadenectomy in the case of metastases detection. Treatment of localized disease is limited to radical local excision with complementary radiotherapy. Due to the resistance to classical chemotherapy and the presence of characteristic molecular abnormalities, trials of molecular targeted therapies in this group of cancers are ongoing. In clinical trials, MET inhibitors, tyrosine kinase inhibitors (TKI) — sunitinib and pazopanib were evaluated. CCS was also one of the subtypes of tumours evaluated in the CREATE clinical trial with crizotinib.
Keywords: clear cell sarcomacrizotinibsentinel node biopsysarcomatranslocation
References
- Cornillie J, van Cann T, Wozniak A, et al. Biology and management of clear cell sarcoma: state of the art and future perspectives. Expert Rev Anticancer Ther. 2016; 16(8): 839–845.
- ENZINGER FM. Clear-cell sarcoma of tendons and aponeuroses. An analysis of 21 cases. Cancer. 1965; 18: 1163–1174, doi: 10.1002/1097-0142(196509)18:9<1163::aid-cncr2820180916>3.0.co;2-0.
- Chung EB, Enzinger FM. Malignant melanoma of soft parts. A reassessment of clear cell sarcoma. Am J Surg Pathol. 1983; 7(5): 405–413.
- Lucas DR, Nascimento AG, Sim FH. Clear cell sarcoma of soft tissues. Mayo Clinic experience with 35 cases. Am J Surg Pathol. 1992; 16(12): 1197–1204.
- Clark MA, Johnson MB, Thway K, et al. Clear cell sarcoma (melanoma of soft parts): The Royal Marsden Hospital experience. Eur J Surg Oncol. 2008; 34(7): 800–804.
- Malchau SS, Hayden J, Hornicek F, et al. Clear cell sarcoma of soft tissues. J Surg Oncol. 2007; 95(6): 519–522.
- Bianchi G, Charoenlap C, Cocchi S, et al. Clear cell sarcoma of soft tissue: a retrospective review and analysis of 31 cases treated at Istituto Ortopedico Rizzoli. Eur J Surg Oncol. 2014; 40(5): 505–510.
- Kawai A, Nakayama R, Matsumine A, et al. Clear cell sarcoma of tendons and aponeuroses: an analysis of 75 cases. J Clin Oncol. 2006; 24(Suppl 18): 9572–9572.
- Bali A, Roy M, Chikkannaiah P, et al. Cutaneous clear cell sarcoma: a rare aggressive tumor with potential diagnostic challenge. J Lab Physicians. 2012; 4(1): 53–55.
- Hantschke M, Mentzel T, Rütten A, et al. Cutaneous clear cell sarcoma: a clinicopathologic, immunohistochemical, and molecular analysis of 12 cases emphasizing its distinction from dermal melanoma. Am J Surg Pathol. 2010; 34(2): 216–222.
- Jin L, Sui Y, Zhu H, et al. Primary mediastinal clear cell sarcoma: a case report and review of the literature. Diagn Pathol. 2017; 12(1): 5.
- Abdollahi A, Khatami F, Tavangar SM. Clear cell sarcoma: a case report and review of literature. Int J Hematol Oncol Stem Cell Res. 2018; 12(1): 65–68.
- Kawai A, Hosono A, Nakayama R, et al. Japanese Musculoskeletal Oncology Group. Clear cell sarcoma of tendons and aponeuroses: a study of 75 patients. Cancer. 2007; 109(1): 109–116.
- Gonzaga MI, Grant L, Curtin C, et al. The epidemiology and survivorship of clear cell sarcoma: a National Cancer Database (NCDB) review. J Cancer Res Clin Oncol. 2018; 144(9): 1711–1716.
- Hocar O, Le Cesne A, Berissi S, et al. Clear cell sarcoma (malignant melanoma) of soft parts: a clinicopathologic study of 52 cases. Dermatol Res Pract. 2012; 2012: 984096.
- Yang XL, Lu SJ, Xue J, et al. Clear cell sarcoma of the right lumbar region: a case report and review of the literature. Oncol Lett. 2014; 8(4): 1625–1627.
- Hisaoka M, Ishida T, Kuo TT, et al. Clear cell sarcoma of soft tissue: a clinicopathologic, immunohistochemical, and molecular analysis of 33 cases. Am J Surg Pathol. 2008; 32(3): 452–460.
- Auerbach A, Cassarino DS. Clear cell tumors of soft tissue. Surg Pathol Clin. 2011; 4(3): 783–798.
- Yang L, Chen Y, Cui T, et al. Identification of biomarkers to distinguish clear cell sarcoma from malignant melanoma. Hum Pathol. 2012; 43(9): 1463–1470.
- Patel RM, Downs-Kelly E, Weiss SW, et al. Dual-color, break-apart fluorescence in situ hybridization for EWS gene rearrangement distinguishes clear cell sarcoma of soft tissue from malignant melanoma. Mod Pathol. 2005; 18(12): 1585–1590.
- Meis-Kindblom JM. Clear cell sarcoma of tendons and aponeuroses: a historical perspective and tribute to the man behind the entity. Adv Anat Pathol. 2006; 13(6): 286–292.
- Mrózek K, Karakousis CP, Perez-Mesa C, et al. Translocation t(12;22)(q13;q12.2-12.3) in a clear cell sarcoma of tendons and aponeuroses. Gene Chromosome Canc. 1993; 6(4): 249–252.
- Reeves BR, Fletcher CD, Gusterson BA. Translocation t(12;22)(q13;q13) is a nonrandom rearrangement in clear cell sarcoma. Cancer Genet Cytogenet. 1992; 64(2): 101–103.
- Davis IJ, Kim JJ, Ozsolak F, et al. Oncogenic MITF dysregulation in clear cell sarcoma: defining the MiT family of human cancers. Cancer Cell. 2006; 9(6): 473–484.
- Panagopoulos I, Mertens F, Dębiec-Rychter M, et al. Molecular genetic characterization of the EWS/ATF1 fusion gene in clear cell sarcoma of tendons and aponeuroses. Int J Cancer. 2002; 99(4): 560–567.
- Fisher C. The diversity of soft tissue tumours with EWSR1 gene rearrangements: a review. Histopathology. 2014; 64(1): 134–150.
- Rossi S, Szuhai K, Ijszenga M, et al. EWSR1-CREB1 and EWSR1-ATF1 fusion genes in angiomatoid fibrous histiocytoma. Clin Cancer Res. 2007; 13(24): 7322–7328.
- Mavrogenis Af, Bianchi G, Stavropoulos Na, et al. Clinicopathological features, diagnosis and treatment of clear cell sarcoma/melanoma of soft parts. Hippokratia. 2013; 17(4): 298–302.
- Davis IJ, McFadden AW, Zhang Y, et al. Identification of the receptor tyrosine kinase c-Met and its ligand, hepatocyte growth factor, as therapeutic targets in clear cell sarcoma. Cancer Res. 2010; 70(2): 639–645.
- Negri T, Brich S, Conca E, et al. Receptor tyrosine kinase pathway analysis sheds light on similarities between clear-cell sarcoma and metastatic melanoma. Gene Chromosome Canc. 2012; 51(2): 111–126.
- Pearl ML, Inagami M, McCauley DL, et al. Mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) chemotherapy for gynecological sarcomas. Int J Gynecol Cancer. 2002; 12(6): 745–748.
- Mariappan D, Shashikala Dr. Molecular genetics, diagnosis and management of clear cell sarcoma of hand. IOSR-JDMS. 2016; 15(07): 15–22.
- Deyrup AT. Paraganglioma-like dermal melanocytic tumor: a unique entity distinct from cellular blue nevus, clear cell sarcoma, and cutaneous melanoma. Am J Surg Pathol. 2004; 28(12): 1579–1586.
- Thyvalappil A, Sudhamani B, Kizhakkethara G, et al. Paraganglioma-like dermal melanocytic tumor. Indian J Dermatol. 2015; 60(1): 80–81.
- Folpe AL, Goodman ZD, Ishak KG, et al. Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults. Am J Surg Pathol. 2000; 24(9): 1239–1246.
- Beuckeleer LHDe, Schepper AMDe, Vandevenne JE, et al. MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review. Skeletal Radiology. 2000; 29(4): 187–195.
- Tordjman M, Dubois M, de Malherbe M, et al. Clear cell sarcoma of the tongue on MRI and PET/CT. Clin Nucl Med. 2018; 43(4): e118–e121.
- Nguyen BaD, Roarke MC, Ram PC. PET monitoring of clear cell sarcoma of tendons and aponeuroses. Clin Nucl Med. 2007; 32(5): 415–417.
- Hocar O, Cesne ALe, Terrier P, et al. Clear cell sarcoma (CCS) or malignant melanoma of soft parts: a retrospective clinicopathologic study of 52 cases. J Oncol. 2008; 26(Suppl 15): 10576–10576.
- Pasquali S, Gronchi A. Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications. Ther Adv Med Oncol. 2017; 9(6): 415–429.
- Boglione A, Bergnolo P, Canton OD, et al. P04Systemic therapy in clear cell sarcoma (CCS). Annals of Oncology. 2016; 27(Suppl 4): 99.
- Jones RL, Constantinidou A, Thway K, et al. Chemotherapy in clear cell sarcoma. Med Oncol. 2011; 28(3): 859–863.
- Yalcin S, Barista I, Tekuzman G, et al. Dramatic response to ifosfamide, mesna and doxorubicin chemotherapy regimen in an adult with clear cell sarcoma of the kidney. J Urol. 1996; 155(6): 2024.
- Tazzari M, Palassini E, Vergani B, et al. Melan-A/MART-1 immunity in a EWS-ATF1 translocated clear cell sarcoma patient treated with sunitinib: a case report. BMC Cancer. 2015; 15: 58.
- Juel J, Ibrahim RM. A case of clear cell sarcoma-A rare malignancy. Int J Surg Case Rep. 2017; 36: 151–154.
- Abdellah A, Soufiane B, Amine B, et al. Clear cell sarcoma of tendons and aponeuroses of the parapharyngeal space: an unusual localization of a rare tumor (a case report and review of the literature). Pan Afr Med J. 2014; 19: 147.
- van Akkooi ACJ, Verhoef C, van Geel AN, et al. Sentinel node biopsy for clear cell sarcoma. Eur J Surg Oncol. 2006; 32(9): 996–999.
- Andreou D, Boldt H, Werner M, et al. Sentinel node biopsy in soft tissue sarcoma subtypes with a high propensity for regional lymphatic spread — results of a large prospective trial. Ann Oncol. 2013; 24(5): 1400–1405.
- Al-Refaie WB, Ali MW, Chu DZ, et al. Clear cell sarcoma in the era of sentinel lymph node mapping. J Surg Oncol. 2004; 87(3): 126–129.
- Tong TR, Chow Tc, Chan OWh, et al. Clear-cell sarcoma diagnosis by fine-needle aspiration: cytologic, histologic, and ultrastructural features; potential pitfalls; and literature review. Diagn Cytopathol. 2002; 26(3): 174–180.
- Ferrari A, Casanova M, Bisogno G, et al. Clear cell sarcoma of tendons and aponeuroses in pediatric patients: a report from the Italian and German Soft Tissue Sarcoma Cooperative Group. Cancer. 2002; 94(12): 3269–3276.
- Picciotto F, Zaccagna A, Derosa G, et al. Clear cell sarcoma (malignant melanoma of soft parts) and sentinel lymph node biopsy. Eur J Dermatol. 2005; 15(1): 46–48.
- Nishida Y, Yamada Y, Tsukushi S, et al. Sentinel lymph node biopsy reveals a positive popliteal node in clear cell sarcoma. Anticancer Res. 2005; 25(6C): 4413–4416.
- Fantini F, Monari P, Bassissi S, et al. Sentinel lymph node biopsy in clear cell sarcoma. J Eur Acad Dermatol Venereol. 2007; 21(9): 1271–1272.
- Deenik W, Mooi WJ, Rutgers EJ, et al. Clear cell sarcoma (malignant melanoma) of soft parts: A clinicopathologic study of 30 cases. Cancer. 1999; 86(6): 969–975, doi: 10.1002/(sici)1097-0142(19990915)86:6<969::aid-cncr11>3.3.co;2-q.
- Constantinidou A, Jones RL, Al-Muderis O, et al. Systemic therapy in clear cell sarcoma. J Clin Oncol. 2010; 28(Suppl 15): 10098–10098.
- Stacchiotti S, Palassini E, Negri T, et al. Clear cell sarcoma (CCR): Clinical behavior and response to chemotherapy. J Clin Oncol. 2010; 28(Suppl 15): 10096–10096.
- Fujimoto M, Hiraga M, Kiyosawa T, et al. Complete remission of metastatic clear cell sarcoma with DAV chemotherapy. Clin Exp Dermatol. 2003; 28(1): 22–24.
- Tran H, Asfour V, Chang C, et al. Clear cell sarcoma arising from the iliac wing: case report. I J Oncol. 2009; 6(2): 1–5.
- Kumar Kushwaha A, Soni S. Metastatic Clear Cell Sarcoma Role of Temazolamide. Journal of Dental and Medical Sciences 2016. OSR-JDMS. 2016; 15(12, ver. II): 8–9.
- Katz D, Palmerini E, Pollack SM. More than 50 subtypes of soft tissue sarcoma: paving the path for histology-driven treatments. Am Soc Clin Oncol Educ Book. 2018(38): 925–938.
- Goldberg J, Demetri GD, Choy E, et al. Preliminary results from a phase II study of ARQ 197 in patients with microphthalmia transcription factor family (MiT)-associated tumors. Journal of Clinical Oncology, 2009. J Clin Oncol. 2009; 27(15S): 10502–10502.
- Wagner AJ, Goldberg JM, Dubois SG, et al. Tivantinib (ARQ 197), a selective inhibitor of MET, in patients with microphthalmia transcription factor-associated tumors: results of a multicenter phase 2 trial. Cancer. 2012; 118(23): 5894–5902.
- Schöffski P, Wozniak A, Stacchiotti S, et al. Activity and safety of crizotinib in patients with advanced clear-cell sarcoma with MET alterations: European Organization for Research and Treatment of Cancer phase II trial 90101 'CREATE'. Ann Oncol. 2017 [Epub ahead of print]; 28(12): 3000–3008.
- Mir O, Boudou-Rouquette P, Larousserie F, et al. Objective response to sorafenib in advanced clear-cell sarcoma. Ann Oncol. 2012; 23(3): 807–809.
- Stacchiotti S, Grosso F, Negri T, et al. Tumor response to sunitinib malate observed in clear-cell sarcoma. Ann Oncol. 2010; 21(5): 1130–1131.
- Chi Y, Fang Z, Hong X, et al. Safety and efficacy of anlotinib, a multikinase angiogenesis inhibitor, in patients with refractory metastatic soft-tissue sarcoma. Clin Cancer Res. 2018 [Epub ahead of print].
- Steger GG, Wrba F, Mader R, et al. Complete remission of metastasised clear cell sarcoma of tendons and aponeuroses. Eur J Cancer. 1991; 27(3): 254–256.
- Lauro S, Bordin F, Trasatti L, et al. Concurrent chemoimmunotherapy in metastatic clear cell sarcoma: a case report. Tumori. 1999; 85(6): 512–514.
- Marcrom S, De Los Santos JF, Conry RM. Complete response of mediastinal clear cell sarcoma to pembrolizumab with radiotherapy. Clin Sarcoma Res. 2017; 7: 14.
- Scheinberg T, Lomax A, Tattersall M, et al. PD-1 blockade using pembrolizumab in adolescent and young adult patients with advanced bone and soft tissue sarcoma. J Clin Oncol. 2017; 35(Suppl 15): 3060.
- Goldberg JM, Fisher DE, Demetri GD, et al. Biologic activity of autologous, granulocyte-macrophage colony-stimulating factor secreting alveolar soft-part sarcoma and clear cell sarcoma vaccines. Clin Cancer Res. 2015; 21(14): 3178–3186.
- Tsukahara T, Emori M, Murata K, et al. The future of immunotherapy for sarcoma. Expert Opin Biol Ther. 2016; 16(8): 1049–1057.
- Kuiper DR, Hoekstra HJ, Veth RPH, et al. The management of clear cell sarcoma. Eur J Surg Oncol. 2003; 29(7): 568–570.
- Lewis JJ, Leung D, Heslin M, et al. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol. 1997; 15(2): 646–652.
- Firmin N, Boudou-Rouquette P, Duliege D, et al. Outcome of 91 clear cell sarcoma tumor patients: A retrospective study from the French Sarcoma Group (GSF-GETO). J clin Oncol. 2018; 36(Suppl 15): 11552–11552.
- Hong D, Rosen P, Lockhart A, et al. A first-in-human study of AMG 208, an oral MET inhibitor, in adult patients with advanced solid tumors. Oncotarget. 2015; 6(21): 18693–18706.