title: Clear cell sarcoma of tendons and aponeuroses: a review.
abstract: Clear cell sarcoma of tendons and aponeuroses, also referred to as malignant melanoma of soft parts, is a rare malignancy derived from neural crest cells. It usually presents in the distal lower extremities of young adults, frequently attached to tendons or aponeuroses. It behaves like a high-grade soft tissue sarcoma and is associated with poor overall survival. Magnetic resonance imaging studies of the lesion reveal T1 hypointensity, T2 hyperintensity, and gadolinium uptake. Grossly, the tumor is usually circumscribed with a histologic pattern of uniform polygonal to fusiform cells with clear to pale eosinophilic cytoplasm divided into variably sized clusters by fibrous septa. Immunohistochemical studies in most cases show that the neoplastic cells are positive with HMB-45 and react with antibody against S100 protein. Most cases show a reciprocal cytogenetic translocation t(12;22)(q13;q12) that creates a unique chimeric fusion EWSR1/ATF1 gene transcript. Metastasis occurs mainly to regional lymph nodes and lungs. Poor prognostic indicators include a tumor size equal to or more than 5 cm, presence of metastasis, and necrosis. The mainstay of treatment is wide excision of the tumor. The use of sentinel lymph node biopsy may become an important procedure in detecting occult regional metastasis and guiding the extent of surgery. The beneficial effects of adjuvant chemotherapy and radiotherapy have not been fully evaluated. This article provides a short overview of the current knowledge of clear cell sarcoma of tendons and aponeuroses.
authors.affiliation: Department of Pathology, University of Missouri at Kansas City School of Medicine/Truman Medical Center, 2301 Holmes St, Kansas City, MO 64108-2677, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Dim
authors.forename: Linda D
authors.initials: LD
authors.lastname: Cooley
authors.forename: Roberto N
authors.initials: RN
authors.lastname: Miranda
mesh_terms: D051697:Activating Transcription Factor 1; D000951:Antigens, Neoplasm; D002148:Calmodulin-Binding Proteins / Q000235:genetics; D004268:DNA-Binding Proteins / Q000235:genetics; D003937:Diagnosis, Differential; D006801:Humans; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins / Q000378:metabolism; D009372:Neoplasms, Connective Tissue / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D009687:Nuclear Proteins / Q000235:genetics; D011379:Prognosis; D034802:RNA-Binding Protein EWS; D016601:RNA-Binding Proteins / Q000235:genetics; D000071701:Regulatory Factor X Transcription Factors; D009418:S100 Proteins / Q000378:metabolism; D018227:Sarcoma, Clear Cell / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D013710:Tendons / Q000473:pathology; D014157:Transcription Factors; D014178:Translocation, Genetic
chemical_list: C531110:ATF1 protein, human; D051697:Activating Transcription Factor 1; D000951:Antigens, Neoplasm; D002148:Calmodulin-Binding Proteins; D004268:DNA-Binding Proteins; C500986:EWSR1 protein, human; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; D034802:RNA-Binding Protein EWS; D016601:RNA-Binding Proteins; D000071701:Regulatory Factor X Transcription Factors; D009418:S100 Proteins; D014157:Transcription Factors