Gastroblastoma Treated by Endoscopic Submucosal Excavation with a Novel PTCH1::GLI2 Fusion: A Rare Case Report and Literature Review
Abstract
:1. Introduction
2. Case Presentation
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Papke, D.J., Jr.; Hornick, J.L. Recent developments in gastroesophageal mesenchymal tumours. Histopathology 2021, 78, 171–186. [Google Scholar] [CrossRef] [PubMed]
- Wey, E.A.; Britton, A.J.; Sferra, J.J.; Kasunic, T.; Pepe, L.R.; Appelman, H.D. Gastroblastoma in a 28-year-old man with nodal metastasis: Proof of the malignant potential. Arch. Pathol. Lab. Med. 2012, 136, 961–964. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Miettinen, M.; Dow, N.; Lasota, J.; Sobin, L.H. A distinctive novel epitheliomesenchymal biphasic tumor of the stomach in young adults (“gastroblastoma”): A series of 3 cases. Am. J. Surg. Pathol. 2009, 33, 1370–1377. [Google Scholar] [CrossRef]
- Graham, R.P.; Nair, A.A.; Davila, J.I.; Jin, L.; Jen, J.; Sukov, W.R.; Wu, T.T.; Appelman, H.D.; Torres-Mora, J.; Perry, K.D.; et al. Gastroblastoma harbors a recurrent somatic MALAT1-GLI1 fusion gene. Mod. Pathol. 2017, 30, 1443–1452. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chen, C.; Lu, J.; Wu, H. Case Report: Submucosal gastroblastoma with a novel PTCH1::GLI2 gene fusion in a 58-year-old man. Front. Oncol. 2022, 12, 935914. [Google Scholar] [CrossRef] [PubMed]
- Koo, S.C.; LaHaye, S.; Kovari, B.P.; Schieffer, K.M.; Ranalli, M.A.; Aldrink, J.H.; Michalsky, M.P.; Colace, S.; Miller, K.E.; Bedrosian, T.A.; et al. Gastroblastoma with a novel EWSR1-CTBP1 fusion presenting in adolescence. Genes Chromosomes Cancer 2021, 60, 640–646. [Google Scholar] [CrossRef]
- Long, W.G.; Zhuang, Y.; Li, M.; Zheng, F.; Zhong, A.J.; Wang, D.Q.; Wu, J.N. Gastroblastoma: Report of a case. Zhonghua Bing Li Xue Za Zhi 2020, 49, 761–763. [Google Scholar] [CrossRef]
- Pinto, D.N.; Ventura, J.; Gomes, D.; Brito, T.; Leite, M.; Monteiro, C.; Matos, C.; Fazeres, F.; Lopes, L.; Midões, A. Gastroblastoma described in adult patient. Int. J. Case Rep. Images 2019, 2019, 10. [Google Scholar]
- Castri, F.; Ravegnini, G.; Lodoli, C.; Fiorentino, V.; Abatini, C.; Giustiniani, M.C.; Angelini, S.; Ricci, R. Gastroblastoma in old age. Histopathology 2019, 75, 778–782. [Google Scholar] [CrossRef]
- Centonze, G.; Mangogna, A.; Salviato, T.; Belmonte, B.; Cattaneo, L.; Monica, M.A.T.; Garzone, G.; Brambilla, C.; Pellegrinelli, A.; Melotti, F.; et al. Gastroblastoma in Adulthood-A Rarity among Rare Cancers-A Case Report and Review of the Literature. Case Rep. Pathol. 2019, 2019, 4084196. [Google Scholar] [CrossRef]
- Toumi, O.; Ammar, H.; Korbi, I.; Ayed, M.; Gupta, R.; Nasr, M.; Salem, R.; Hadhri, R.; Zayed, S.; Noomen, F.; et al. Gastroblastoma, a biphasic neoplasm of stomach: A case report. Int. J. Surg. Case Rep. 2017, 39, 72–76. [Google Scholar] [CrossRef] [PubMed]
- Ma, Y.; Zheng, J.; Zhu, H.; Dong, K.; Zheng, S.; Xiao, X.; Chen, L. Gastroblastoma in a 12-year-old Chinese boy. Int. J. Clin. Exp. Pathol. 2014, 7, 3380–3384. [Google Scholar] [PubMed]
- Fernandes, T.; Silva, R.; Devesa, V.; Lopes, J.M.; Carneiro, F.; Viamonte, B. AIRP best cases in radiologic-pathologic correlation: Gastroblastoma: A rare biphasic gastric tumor. Radiographics 2014, 34, 1929–1933. [Google Scholar] [CrossRef] [PubMed]
- Shin, D.H.; Lee, J.H.; Kang, H.J.; Choi, K.U.; Kim, J.Y.; Park, D.Y.; Lee, C.H.; Sol, M.Y.; Park, J.H.; Kim, H.Y.; et al. Novel epitheliomesenchymal biphasic stomach tumour (gastroblastoma) in a 9-year-old: Morphological, ultrastructural and immunohistochemical findings. J. Clin. Pathol. 2010, 63, 270–274. [Google Scholar] [CrossRef]
- Prall, O.W.J.; McEvoy, C.R.E.; Byrne, D.J.; Iravani, A.; Browning, J.; Choong, D.Y.; Yellapu, B.; O’Haire, S.; Smith, K.; Luen, S.J.; et al. A Malignant Neoplasm From the Jejunum With a MALAT1-GLI1 Fusion and 26-Year Survival History. Int. J. Surg. Pathol. 2020, 28, 553–562. [Google Scholar] [CrossRef]
- Antonescu, C.R.; Agaram, N.P.; Sung, Y.S.; Zhang, L.; Swanson, D.; Dickson, B.C. A Distinct Malignant Epithelioid Neoplasm With GLI1 Gene Rearrangements, Frequent S100 Protein Expression, and Metastatic Potential: Expanding the Spectrum of Pathologic Entities With ACTB/MALAT1/PTCH1-GLI1 Fusions. Am. J. Surg. Pathol. 2018, 42, 553–560. [Google Scholar] [CrossRef]
- Chetty, R. Gene of the month: GLI-1. J. Clin. Pathol. 2020, 73, 228–230. [Google Scholar] [CrossRef]
- Cohen, M.; Kicheva, A.; Ribeiro, A.; Blassberg, R.; Page, K.M.; Barnes, C.P.; Briscoe, J. Ptch1 and Gli regulate Shh signalling dynamics via multiple mechanisms. Nat. Commun. 2015, 6, 6709. [Google Scholar] [CrossRef]
- Pietrobono, S.; Gagliardi, S.; Stecca, B. Non-canonical Hedgehog Signaling Pathway in Cancer: Activation of GLI Transcription Factors Beyond Smoothened. Front. Genet. 2019, 10, 556. [Google Scholar] [CrossRef] [Green Version]
- Kim, S.H.; Da Cruz Paula, A.; Basili, T.; Dopeso, H.; Bi, R.; Pareja, F.; da Silva, E.M.; Gularte-Merida, R.; Sun, Z.; Fujisawa, S.; et al. Identification of recurrent FHL2-GLI2 oncogenic fusion in sclerosing stromal tumors of the ovary. Nat. Commun. 2020, 11, 44. [Google Scholar] [CrossRef] [Green Version]
- Punjabi, L.S.; Goh, C.H.R.; Sittampalam, K. Expanding the spectrum of GLI1-altered mesenchymal tumors-A high-grade uterine sarcoma harboring a novel PAMR1::GLI1 fusion and literature review of GLI1-altered mesenchymal neoplasms of the gynecologic tract. Genes Chromosomes Cancer 2022. [Google Scholar] [CrossRef] [PubMed]
- Ambrosio, M.; Virgilio, A.; Raffone, A.; Arena, A.; Raimondo, D.; Alletto, A.; Seracchioli, R.; Casadio, P. Malignant epithelioid neoplasm of the ileum with ACTB-GLI1 fusion mimicking an adnexal mass. BMC Womens Health 2022, 22, 104. [Google Scholar] [CrossRef] [PubMed]
Author | Time | Age | Country | Sex | Main Complaint | Images |
---|---|---|---|---|---|---|
Selene C. Koo [6] | 2021 | 17 | USA | M | 3 days of bright red hematemesis and melena | EGD showed a large ulcerated sessile submucosal gastric mass. (No further detail has been described) |
Long Weiguo [7] | 2020 | 53 | China | F | 1 year of epigastric pain and discomfort | CT showed a lobulated mass in the antrum with exophytic growth towards the lumen, with clear borders and uneven enhancement. |
Diogo Nogueira Pinto [8] | 2019 | 53 | Portugal | F | Heartburn and dyspepsia | UDE showed a submucosal lesion. EUS showed the lesion was hypoechogenic with irregular border, cystic components and calcifications. |
Federica Castri [9] | 2019 | 79 | Italy | M | Weight loss and dysphagia | Contrast-enhanced CT showed an antral transmural thickening. EUS showed a submucosal hypoecogenic mass. |
Giovanni Centonze [10] | 2019 | 43 | Italy | F | bleeding | Endoscope revealed a submucosal, ulcerated lesion and it showed inhomogeneous enhancement in EUS and CT. |
Omar Toumi [11] | 2017 | 29 | Tunisia | F | 8 months of epigastric pain and 2 days of hematemesis | Upper gastrointestinal endoscopy revealed a submucosal lesion. CT scan showed the tumor was solid-cystic. |
Rondell P Graham [4] | 2017 | 27 | USA | M | Not mentioned | Not mentioned. |
56 | F | Not mentioned | Not mentioned. | |||
Ma Yangyang [12] | 2014 | 12 | China | M | More than 3 months of intermittent blood in stool and abdominal mass | CT and MRI revealed a mass in the gastric antrum, and gastroscope showed the mass had an ulcer approximately 2 × 1 cm. |
Teresa Fernandes [13] | 2014 | 19 | Portugal | F | 5 months of diffuse abdominal pain and a mass in the right quadrants of the abdomen | Abdominal ultrasonography revealed an anechoic well-defined complex cystic lesion. CT showed the mass was lobulated with some foci of punctiform calcification. The wall, internal septa and adenopathy demonstrated moderate enhancement after administration of intravenous contrast material. MRI showed the fluid content of the loculi was homogeneously hypointense on T1-weighted images and markedly hyperintense on T2-weighted images. |
Elizabeth A. Wey [2] | 2012 | 28 | USA | M | Constipation after a motor vehicle accident | CT revealed a heterogeneous mass in the gastric antrum. (No further detail has been described.) |
Dong Hoon Shin [14] | 2010 | 9 | Korea | M | 3 months of abdominal pain and a periumbilical mass | CT revealed a solid and cystic gastric antral mass which compressed the adjacent duodenum, gallbladder and pancreas. |
Markku Miettinen [3] | 2009 | 19 | USA | M | Nonspecific abdominal pain | Not mentioned. |
27 | F | Nonspecific abdominal pain | Not mentioned. | |||
30 | M | Anemia, fatigue | Not mentioned. |
Author | Mutation | IHC (+) | IHC (−) |
---|---|---|---|
Selene C. Koo [6] | EWSR1-CTBP1 fusion and overexpressed NOTCH and FGFR | Vimentin, CD56, CD10, PCK and Syn, Ki-67 (5%) | CD34, DOG1, CD117, S100, desmin, CgA |
Long Weiguo [7] | Not mentioned | PCK e, vimentin s, CD10, CD56, Ki-67 (<2%) | SMA, calponin, calretinin, CD117, CD34, DOG1, CK5/6, CK7, CK20, S100, CgA, SDHB |
Diogo Nogueira Pinto [8] | Not mentioned | Vimentin s, CD10, CD56, MNF e, CAM5.2 e, AE1/AE3 e, Ki-67 (<5%) | CD34, CD117, desmin, caldesmon, HMB45, WT1, Syn |
Federica Castri [9] | MALAT1-GLI1 fusion | Vimentin s, CD10, cytokeratins AE1/AE3, CD56 | α-FP, β-HCG, h-caldesmon, calponin, CD31, CD99, CD117, CgA, desmin, DOG1, GFAP, HMB45, MelanA, S100, STAT6, Syn |
Giovanni Centonze [10] | Not mentioned (but IHC showed an extensive positivity for GLI in nucleus and cytoplasm) | EMA e, CAM5.2 e, AE1/AE3 e, PCK e, LMWCK e, CK7 e, CK19 e, vimentin s, CD10 s, GLI | SMA, CD117, DOG1, TLE1, CD34, CD99, inhibin, SMA, CK20, CK5/6, CDX-2, S100, p63, TTF1, calretinin, Syn, CgA, PDGFRA, p16, estrogen and progesterone receptor |
Omar Toumi [11] | Not mentioned | Vimentin, CD99, CD10 | Cytokeratin, CgA, Syn, C-kit |
Rondell P Graham [4] | MALAT1-GLI1 fusion | AE1/AE3 e, patchy SMA s | CgA, Syn, KIT, DOG1, desmin, S100, melan-A, SOX10, TLE-1, CD99, keratin5/6 |
MALAT1-GLI1 fusion | Patchy OSCAR e, vimentin s, Ki-67 (approximately 10%) | KRT 34βE12, KRT7, KRT 20, CDX2, CgA, Syn, CD34, CD99, KIT, DOG1, calretinin, WT1, SMA, desmin, EMA, MOC31, melan-A, HMB-45, pCEA | |
Ma Yangyang [12] | SS18 gene rearrangement was not detected | Vimentin s, CD10 s, CD56 s, PCK e (AE1/AE3 and CAM5.2), LMWCK e, Ki 67(1% in the most area and 40% in focal areas) | CK7, CK5/6, CK19, CK20, HMWCK, S100, EMA, SMA, desmin, caldesmon, CD34, c-KIT (CD117), PLAP, Syn, CgA, NSE, HMB45, A103, calretinin, ALK, P63, DOG1, CD34, CD99, inhibin, CDX2 |
Teresa Fernandes [13] | Not mentioned | Vimentin s, PCK e (AE1/AE3 and CAM5.2), CD56, CD10 | C-KIT, DOG-1, CD34, S100, calretinin, CgA, Syn, desmin |
Elizabeth A. Wey [2] | MALAT1-GLI1 fusion | PCK (AE1/AE3/CAM5.2) e, LMWCK e, CK7 e, vimentin s, CD56, CD10, c-KIT e, NSE e, Ki-67 (10%) | CgA, Syn, CEA, TTF-1, PLAP, CD30, AFP, HCG, CK20, calretinin, CDX2, desmin, EMA, inhibin, p63, S100, SMA |
Dong Hoon Shin [14] | MALAT1-GLI1 fusion. C-KIT mutational analysis of exons 9, 11, 13 and 17 showed no abnormality. | PCK (AE1/AE3) e, LMWCK e, EMA e, c-KIT e, CD56, vimentin s, CD10 s | CD34, CEA, CgA, calretinin, desmin, inhibin, NSE, p63, Syn, SMA |
Markku Miettinen [3] | None of them demonstrated SS18 gene rearrangement. | Vimentin s, CD10 s, AE1/AE3 e, keratin 18 e, focally keratin 7 e | CD34, CD99, estrogen receptor, KIT, calretinin, keratins5/6,20, CD117, CDX2, CgA, CK5/6, CK20, desmin, EMA, SMA, p63, S100, Syn, TTF1 |
Author | Gastroblastoma | Metastasis | Treatment | Follow-Up Months | Recurrence | ||
---|---|---|---|---|---|---|---|
Size (cm) | Location | Infiltration | |||||
Selene C. Koo [6] | 6.3 | Gastric fundus | Centered on the gastric muscularis propria without subserosal extension | No | Partial gastrectomy | 23 | No |
Long Weiguo [7] | 5.0 × 6.0 | Great curvature near gastric antrum | Into gastric muscularis propria | No | Tumorectomy | 14 | No |
Diogo Nogueira Pinto [8] | 2.27 × 2.18 | Great curvature near gastric antrum | Centered in the muscular layer | No | Laparoscopic atypical gastrectomy | 18 | No |
Federica Castri [9] | 3, 1.1 and 0.5 | Gastric antrum | Submucosa | No | Partial gastrectomy | Not mentioned | Yes 1 |
Giovanni Centonze [10] | 5.3 | Gastric antrum | Transmural (originated from the muscularis propria with an endoluminal growth) | No | Distal gastrectomy by laparoscopy | 100 | No |
Omar Toumi [11] | 7 × 4 × 4 | Near the gastric cardia | Transmural with encroachment of the splenic hilum | Yes 2 | Atypical partial gastrectomy with splenectomy | 6 | Yes 3 |
Rondell P Graham [4] | Not mentioned | Not mentioned | Not mentioned | No | Resection (not specific described) | 12 | No |
4.0 | Not mentioned | Not mentioned | Yes (liver) | Not mentioned (the patient was diagnosed by needle biopsy) | NA | NA | |
Ma Yangyang [12] | 4.5 × 2.5 × 2.5 | In the gastric antrum near the lesser curvature | Transmural | No | Subtotal gastrectomy and gastroduodenostomy | 8 | No |
Teresa Fernandes [13] | 10.5 in its largest dimension | Gastric antrum | Centered in the muscular layer | No | Resection of the tumor and partial distal gastrectomy with 15 lymph nodes resected | 20 | No |
Elizabeth A. Wey [2] | 3.8 × 3.3 × 2.5 | Gastric antrum | Transmural (involved the lamina propria, dissected through the muscularis propria into the subserosa) | Yes 4 | 6 weeks of chemotherapy with no response, and a partial gastrectomy | 3 | No |
Dong Hoon Shin [14] | 9.0 × 6.5 | Gastric antrum | Centered in the muscularis propria and protruded towards the subserosa | No | Resection of the tumor and a segmental resection of gastric antrum and pylorus during explorative laparotomy. | 93 | No |
Markku Miettinen [3] | 5 × 4 × 2.5 | Greater curvature of the gastric body | One tumor was transmural, and 2 spanned from superficial muscularis propria into the subserosa. | No | Subtotal gastrectomy | 42 | No |
6 × 4 × 3.5 | Greater curvature of the gastric body | No | Partial gastrectomy | 60 | No | ||
15 × 12 | Gastric antrum | No | Partial gastrectomy | 60 | No |
Category | More Common in | B/M | Located in | Endoscopy | Size | No. | Morphology | IHC | Mutation |
---|---|---|---|---|---|---|---|---|---|
Gastroblastoma | no apparent gender preference, mainly in young adults | M potential | Most seen in gastric antrum | Hypoechoic mass in EUS | 0.5–10.5 cm | Single | Biphasic morphology. Epithelioid component contains cords, nests, sheets and tubules of neoplastic cells with vesicular nuclei and small nucleoli. Spindle cell component contains sheets and fascicles of cells with pale eosinophilic cytoplasm, ovoid nuclei with vesicular chromatin and small nucleoli. | Positive for Vimentin, CD10, CD56, PCK. | MALAT1-GLI1 fusion is the most relevant mutation. |
Granular cell tumor | In female and adult | B | Esophagus, colorectum, anus, stomach, appendix and small bowel | As small polyps or plaques | <1 cm | Solitary, sporadic | Composed of sheets and nests of large, polygonal cells with small, hyperchromatic nuclei (with evenly dispersed chromatin) and granular eosinophilic cytoplasm. | Diffusely express SOX10, S-100 protein, CD68, NKI-C3, and overexpress TFE3. | In ATP6AP1, ATP6AP2 and ATP6V0C |
Plexiform fibromyxoma | No apparent gender preference, during 40–50 years old | B | Gastric antrum and pylorus, duodenum, jejunum, gallbladder and mediastinum | Appears as a tan/pink, rubbery mass and is centered in the muscularis propria. | 0.8–17.0 cm | Single | It exhibits multinodular or plexiform growth of spindly to stellate neoplastic cells in a myxoid stroma. Neoplastic cells are bland, with ovoid to tapering nuclei and delicate eosinophilic cytoplasm. Mitotic figures are rarely seen. | Positive for SMA, vimentin and desmin, negative for ALK, CD34, CD117, KIT, ANO1 (DOG1), EMA and S-100 protein | MALAT1-GLI1 gene fusions, GLI1 amplification and PTCH1 deletions |
GIST (gastrointestinal stromal tumors) | No apparent gender preference, in middle-aged adults | M with a metastatic potential | Stomach and other GI tract (small and large intestines) | Hypoechoic mass in EUS which situated within the muscularis propria and may extend to the subserosa. | 0.2–30 mm or larger | Sporadic | With various cytologic and growth patterns, the lesion was composed of fascicular or sheet-like growth of spindle cells or of admixed epithelioid and spindle cells. | KIT positive, CD117, DOG1 | KIT* |
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Liu, Y.; Wu, H.; Wu, X.; Feng, Y.; Jiang, Q.; Wang, Q.; Yang, A. Gastroblastoma Treated by Endoscopic Submucosal Excavation with a Novel PTCH1::GLI2 Fusion: A Rare Case Report and Literature Review. Curr. Oncol. 2022, 29, 8862-8873. https://doi.org/10.3390/curroncol29110697
Liu Y, Wu H, Wu X, Feng Y, Jiang Q, Wang Q, Yang A. Gastroblastoma Treated by Endoscopic Submucosal Excavation with a Novel PTCH1::GLI2 Fusion: A Rare Case Report and Literature Review. Current Oncology. 2022; 29(11):8862-8873. https://doi.org/10.3390/curroncol29110697
Chicago/Turabian StyleLiu, Yongru, Huanwen Wu, Xi Wu, Yunlu Feng, Qingwei Jiang, Qiang Wang, and Aiming Yang. 2022. "Gastroblastoma Treated by Endoscopic Submucosal Excavation with a Novel PTCH1::GLI2 Fusion: A Rare Case Report and Literature Review" Current Oncology 29, no. 11: 8862-8873. https://doi.org/10.3390/curroncol29110697
APA StyleLiu, Y., Wu, H., Wu, X., Feng, Y., Jiang, Q., Wang, Q., & Yang, A. (2022). Gastroblastoma Treated by Endoscopic Submucosal Excavation with a Novel PTCH1::GLI2 Fusion: A Rare Case Report and Literature Review. Current Oncology, 29(11), 8862-8873. https://doi.org/10.3390/curroncol29110697