title: Detection of ASPL/TFE3 fusion transcripts and the TFE3 antigen in formalin-fixed, paraffin-embedded tissue in a series of 18 cases of alveolar soft part sarcoma: useful diagnostic tools in cases with unusual histological features.
abstract: Alveolar soft part sarcoma (ASPS) is a rare malignancy; diagnostic problems may occur when cases present as a metastasis or with unusual morphologic features. In this study, a series of 18 cases with follow-up information were analysed with regard to the ASPL/TFE3 fusion transcripts and immuno-detection of TFE3 using archival formalin-fixed, paraffin-embedded tissues. Novel primers to detect ASPL/TFE3 fusion transcripts, type 1 and 2, were designed. The patients, ten female and eight male, ranged in age from 3 to 46 years; 16 involved soft tissues of the extremities (nine, lower; seven, upper), one involved the uterine cervix and one was a primary bone tumour of the foot. Seven ASPS had unusual morphologic features lacking the typical alveolar pattern. Seven had lung metastases at the time of diagnosis, and three developed lung and brain metastases later. Four patients died of disease (after 1-5 years); four are alive with metastases (after 2-15 years), and ten are alive and well (after 1-10 years). Vascular invasion correlated with metastatic disease. All 18 ASPS, four granular cell tumours (one of which was malignant) and one adrenal cortical carcinoma showed TFE3 immuno-positivity. The 18/18 ASPS showed ASPL/TFE3 fusion transcripts (nine, type 1; nine, type 2), four of which had a balanced translocation. ASPL/TFE3 fusion transcripts were not detected in 25 controls. We conclude that immuno-detection of TFE3 and RT-PCR-based identification of ASPL/TFE3 fusion transcripts in formalin-fixed, paraffin-embedded tissues are powerful tools in the diagnosis of ASPS, particularly in cases with unusual morphologic features.
authors.affiliation: Department of Musculoskeletal Pathology and Orthopaedic Oncology, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Williams
authors.forename: Gillian
authors.initials: G
authors.lastname: Bartle
authors.forename: Vaiyapuri P
authors.initials: VP
authors.lastname: Sumathi
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Meis
authors.forename: D Chas
authors.initials: DC
authors.lastname: Mangham
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Grimer
authors.forename: Lars-Gunnar
authors.initials: LG
authors.lastname: Kindblom
mesh_terms: D000293:Adolescent; D000328:Adult; D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors / Q000235:genetics*; D001932:Brain Neoplasms / Q000235:genetics / Q000378:metabolism / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D005557:Formaldehyde; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D008175:Lung Neoplasms / Q000235:genetics / Q000378:metabolism / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015514:Oncogene Proteins, Fusion / Q000235:genetics*; D016612:Paraffin Embedding; D011379:Prognosis; D018234:Sarcoma, Alveolar Soft Part / Q000235:genetics* / Q000473:pathology*; D012983:Soft Tissue Neoplasms / Q000235:genetics* / Q000473:pathology*; D016707:Tissue Fixation; D055815:Young Adult
chemical_list: C422743:ASPSCR1 protein, human; D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors; D047908:Intracellular Signaling Peptides and Proteins; D015514:Oncogene Proteins, Fusion; C069203:TFE3 protein, human; D005557:Formaldehyde