Printer Friendly

Revisiting chordoma with brachyury, a "new age" marker: analysis of a validation study on 51 cases.

A chordoma is defined as a low to intermediate grade malignant tumor that recapitulates the notochord and has a tendency for recurrences and metastasis. (1) Although histopathologic features of chordomas are characteristic, a considerable heterogeneity exists, posing a diagnostic challenge in its objective differentiation from other bone tumors, the closest being a chondrosarcoma. (2) This difficulty is compounded when the biopsy is small, and routine immunohistochemical (IHC) markers like cytokeratins (CKs) and epithelial membrane antigen (EMA) display focal expression. (3)

Lately, gene expression analysis has unraveled a key nuclear transcription factor, brachyury or T as a specific marker for chordoma.4 The specificity of this marker has been documented in only a handful of studies, comprising both intraaxial and extraaxial chordomas. (4-6) The present study is an analysis of 51 axial chordomas, with the specific aim of evaluating the value of brachyury in their exact recognition.

MATERIALS AND METHODS

A total of 51 axial chordomas, accessioned during a 10-year period, were retrieved from the case files of the Department of Pathology, Tata Memorial Hospital, Mumbai, India. These comprised specimens of cases operated within this hospital and also consultation cases referred from elsewhere; the latter comprised either specimens (18 cases; 35.2%) or representative slides and paraffin blocks (23 cases; 45.1%). In 10 cases (19.6%) the initial biopsies were also available. Clinicopathologic details were accessed from the hospital charts and referring surgeon's notes.

Treatment details were available in 19 cases (37.25%). Eighteen (94.7%) of these had surgery. Treatment included wide excision (R0) in 11 cases, marginal excision (R1) in 3 cases, intracapsular excision (R2) in 1 case, and excision with unavailable margin status (Rx) in 3 cases. Additionally, 1 patient received neoadjuvant chemotherapy and radiotherapy; another patient received adjuvant radiotherapy; and a single patient received palliative radiotherapy only. In all, 7 cases recurred, 2 of which developed lung metastasis (Table 1).

The chordomas were subtyped into 4 categories: (1) classical chordomas, wherein the tumor cells were seen in a myxoid matrix; (2) chordomas with a chondroid component, where a dominant chondroid component was present, in addition to myxoid areas; (3) chondroid chordomas, wherein almost the entire tumor was composed of chondroid matrix; and (4) dedifferentiated chordomas comprising areas of classical chordoma juxtaposed with unequivocal sarcomatous areas. (4)

Conventional hematoxylin-eosin staining was uniformly performed in all cases.

Brachyury staining was performed in all 51 chordomas (Table 1). Brachyury staining was further performed in the following 2 categories: (1) 58 nonchordomatous tumors, which included 26 chondroid tumors (4 cases of grade I chondrosarcoma, 9 cases of grade II chondrosarcoma, 3 cases of grade III chondrosarcoma, 2 cases of chondromyxoid fibroma, 1 chondroblastoma, 4 osteochondromas, and 2 cases of extraskeletal myxoid chondrosarcoma), 7 liposarcomas, 5 rhabdomyosarcomas, 4 pleomorphic adenomas, 4 mucoepidermoid carcinomas, 4 mucinous adenocarcinomas, 6 germ cell tumors, and 2 cases of renal cell carcinoma (Table 2); and (2) 7 unrelated miscellaneous tissues, which included normal cartilage derived from trachea (2 cases), articular surface (1 case), and testicular tissue (4 cases).

In 23 cases (45%), additional IHC stains for CKs, EMA, and S100 protein were used.

Immunohistochemistry was performed by polymer technique (Dako REAL Envision detection system, Glostrup, Denmark), including peroxidase/3'-3'-diaminobenzidine tetrahydrochloride.

The antibody clones and dilutions were as follows: CK (monoclonal, clone MNF 116; 1:200; Dako), EMA (monoclonal, clone E 29; 1:1200, Dako), S100 protein (polyclonal, 1:600; Dako), vimentin (monoclonal, 1:400; Dako), and brachyury (polyclonal, 1:300, antigen retrieval by pressure cooker at 121[degrees]C, Santa Cruz Biotechnology, Inc, Santa Cruz, California).

Brachyury expression was graded as nil (0), focal nuclear (+), diffuse strong nuclear (++), and diffuse very strong nuclear (+++). Only the latter 2 were regarded as positive. (7)

Specificity and sensitivity for brachyury staining was calculated in chordomas versus the nonchordomatous tumors that formed the differential diagnoses.

RESULTS

The 51 chordomas included 36 men and 15 women, whose age range was 22 to 78 years (mean, 53.25 years; median, 54 years). Sitewise, 34 tumors (66.7%) occurred in the sacrococcyx, 9 cases (17.64%) in the spine, and 8 cases (15.68%) in the skull base.

Tumor dimensions (available in 21 cases) varied from 4 to 17 cm (mean, 10.47 cm; median, 10.1 cm).

On histology, 34 tumors (66.7%) were classified as classical chordomas, 13 (25.5%) as chordomas with dominant chondroid component, 2 cases (3.9%) as chondroid chordomas, and 2 (3.92%) as dedifferentiated chordomas. On correlating site and histology, of the 34 classical chordomas, 27 occurred in sacrococcyx, 5 in the spine, and 2 in the skull base. Of 13 tumors with a dominant chondroid component, 5 were located in the sacrococcyx, 5 in the skull base, and 3 in the spine, whereas the 2 chondroid chordomas involved skull base and sacrococcyx (1 case each). Both the dedifferentiated chordomas occurred in sacrococcyx.

Histologically, a vaguely multilobulated pattern comprising a variable admixture of myxoid and chondroid matrix was observed in all 51 cases, regardless of the subtype. The cells were arranged in sheets, cords, glands, or singly. The characteristic physaliphorous cells, showing abundant, pale, eosinophilic, vacuolated cytoplasm and mild nuclear atypia were noted in all cases (Figure 1, A). Two classical chordomas displayed a rather unusual histology: The first revealed areas of relatively bland spindly morphology amid the vacuolated cells and another case revealed a solid arrangement of epithelioid to "rhabdoid" cells amid the clear cells (Figure 1, B and C). The 2 chondroid chordomas had abundant hyaline chondroid matrix (Figure 2, A). The 2 dedifferentiated chordomas had pleomorphic spindle cell sarcomatous component juxtaposed to the areas of classical chordoma (Figure 2, C).

The results of other IHC markers, where performed, were as follows: CK positive in all (23 of 23 cases; 100%), EMA in 22 of 22 cases (100%), S100 protein in 18 of 21 cases (85.7%), and vimentin in all 10 cases (100%). The 2 cases of dedifferentiated chordomas revealed EMA and CK positivity (Figure 2, D) in the differentiated areas and vimentin reactivity was seen diffusely (Figure 2, E).

All 51 chordomas and the 58 nonchordomatous tumors were evaluated for brachyury expression. This was positive (++ or +++) in 46 chordomas (90.2%) and negative in all the 58 nonchordomatous tumors, including tumors with chondroid and/or myxoid matrix. The remaining 5 chordomas displayed 1+ staining (negative). These included 4 classical chordomas of sacrococcyx (3 cases) and spine (1 case) and 1 case of a skull base chondroid chordoma. Sitewise 31 cases (60.7%) of chordomas in the sacrococcyx, 8 cases (15.6%) in the spine, and 7 cases (13.7%) in the skull base showed positive brachyury expression. On histology, 30 of 34 (88.2%) classical chordomas, 12 of 13 (92.3%) chordomas with a dominant chondroid matrix and 2 chondroid chordomas showed diffuse staining, whereas 2 cases of dedifferentiated chordoma showed positive staining in the differentiated areas and negative staining in the dedifferentiated areas (Figure 1, D through F; Figure 2, B and F). In the group of 58 nonchordomatous tumors, 4 seminomas of 6 germ cell tumors displayed focal, weak staining (+), whereas 1 case each of an embryonal carcinoma and a teratoma showed no staining. However, the spermatogonia in the seminiferous tubules were positive (Figure 3). The remaining 58 cases from the second group and also the cartilage from trachea, larynx, and articular surfaces showed no staining with brachyury.

COMMENT

Chordoma is a rare bone tumor derived from notochordal remnants. (1) The axial skeleton, commonly, the sacral region, followed by the spine and base of skull are well-documented sites of occurrence, as noted in the present study of 51 axial chordomas. (8) Recently, extraaxial chordomas have also been documented. (5,6)

Histopathologically, a chordoma is characterized by the presence of its hallmark physaliphorous cell, embedded in myxoid to chondromyxoid matrix. Despite this unique feature, the variable nature of the accompanying chondromyxoid matrix, presence of bland spindly or epithelioid cells, and at times paucity of physaliphorous cells poses diagnostic difficulties. For therapeutic purpose, distinct recognition of myxoid chondrosarcomas, dedifferentiated chondrosarcomas, and mucinous adenocarcinomas is valuable.

The histologic subtypes recorded in 51 chordomas in the present study, namely classical chordoma (66.7%), chordoma with a dominant chondroid component (25.5%), chondroid chordoma (3.9%), and dedifferentiated chordoma (3.9%), have been observed by others. (3,4,8) The unusual morphology, seen in 2 cases, namely relatively bland spindly growth pattern and a solid growth pattern of epithelioid to rhabdoidlike cells, is also known. (9,10) Traditionally CK, EMA, and S100 protein are the IHC markers that have been used to substantiate a diagnosis of a chordoma, which were done in 23 of 51 chordomas. The expression of epithelial markers, including specific CKs, is known in the notochord and also in chordomas, which are of a notochordal origin. (3,11,12) The differential diagnostic entities of chordoma include extraskeletal myxoid chondrosarcoma, chondrosarcoma, liposarcoma, metastatic mucinous adenocarcinoma, salivary gland carcinoma (head and neck region), myoepithelial tumors, and metastatic renal cell carcinoma. The chordoma with epithelioid to rhabdoidlike cells necessitated differentiation from rhabdomyosarcoma and proximal-type epithelioid sarcoma. (13) Considering the wide and disparate entities listed in the differential diagnosis of chordomas, there is certainly a role for a specific marker for correctly diagnosing a chordoma.

Lately, gene expression profiling has unraveled specific gene signatures for chondroid tumors. (14,15) In a premier study, Vujovic et al (4) have discussed similarities and differences between a chordoma and chondroid tumors. Both these tumors express genes related to cartilage formation, that is, collagen II, SOX 9, fibromodulin, cartilage linking protein, aggrecan, and cartilage oligomeric matrix protein. More importantly, both these tumors have specific markers, as well. Whereas hypertrophic gene collagen [chi], platelet-derived growth factor [alpha], and reticulocalbin 3 have been identified in chondroid tumors, but not in chordomas, specific cytokeratins such as CK8, CK15, and CK19; periplakin; CD24; discoidin domain receptor 1; and brachyury are noticeably expressed in chordoma. (4)

[FIGURE 1 OMITTED]

Some of these markers have been translated at protein level and notably brachyury has been identified as a single specific molecule related to the notochord development and is also seen in chordomas. Brachyury or T is a member of T-box (TBX) gene family and encodes a transcription factor required in posterior mesoderm formation and axial development along with the development of the hemangioblast. Initially it appears in the marginal zone of the blastocyst and subsequently restricts its expression into the notochord and the tail bud. (16) Interestingly, spermatogonia in the seminiferous tubules show positivity, a feature substantiated in the present study. (5) To the best of our knowledge there are only 2 published articles evaluating the specificity of brachyury in diagnosing axial chordomas. (4,17) In the first study by Vujovic and colleagues, (4) chordomas revealed a 100% sensitivity and specificity for brachyury expression, whereas Oakley et al17 observed 89.7% sensitivity and 100% specificity in skull-based chordomas. In the present study, brachyury expression was observed in 90.2% cases with 100% specificity. Absence of specific staining in 5 chordomas, 4 of which were classical chordomas, is most likely the result of inadequate fixation in the referral material from mofussil areas, resulting in poor antibody penetration. The overall high specificity is in keeping with the observations of Vujovic et al. (4) Brachyury has immense value not only in the identification of chordomas at typical sites but also in the identification of chordomas at extraaxial sites and in differentiating myoepitheliomas from chordomas. (5,6,18) The lack of brachyury expression in all nonchordomatous tumors is a very useful observation: Both normal cartilage and chondrosarcomas were negative for brachyury expression. Differentiating chondrosarcoma and chordoma is clinically relevant. Low-grade chondrosarcoma is treated with conservative surgery, whereas chordoma often requires adjuvant radiotherapy, in view of its tendency for recurrences and metastasis. (19) Chondroid chordoma is, however, a relatively favorable subtype of chordoma. (20)

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

CONCLUSION

Brachyury should be included as a useful specific marker in the IHC panel of chordomas along with sensitive but not so specific markers such as CK, EMA, and/or S100 protein. Its positive expression in a substantial number of chordomas and total absence in nonchordomatous tumors supports the hypothesis that chordomas differ from other chondromatous and myxoid tumors. Identification of this specific molecule and its validation at the protein level will possibly open new vistas for targeted therapy for chordoma, a tumor that is often located at anatomically complex sites.

We acknowledge the technical support of Mr Mahendra Palker, MSc, DMLT, and Mrs Rekha Thorat, MSc, DMLT, from the immunohistochemistry laboratory.

References

(1.) McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM. Chordoma: incidence and survival patterns in the United States, 1973-1995. Cancer Causes Control. 2001;12(1):1-11.

(2.) Brooks JJ, Trojanowski JQ, LiVolsi VA. Chondroid chordoma: a low-grade chondrosarcoma and its differential diagnosis. Curr Top Pathol. 1989;80:165-181.

(3.) Meis JM, Giraldo AA. Chordoma: an immunohistochemical study of 20 cases. Arch Pathol Lab Med. 1988;112(5):553-556.

(4.) Vujovic S, Henderson S, Presneau N, et al. Brachyury, a crucial regulator of notochordal development, is a novel biomarker for chordomas. J Pathol. 2006;

209(2):157-165.

(5.) Tirabosco R, Mangham DC, Rosenberg AE, et al. Brachyury expression in extra-axial skeletal and soft tissue chordomas: a marker that distinguishes chordoma from mixed tumor/myoepithelioma/parachordoma in soft tissue. Am J Surg Pathol. 2008;32(4):572-580.

(6.) O'Donnell P, Tirabosco R, Vujovic S, et al. Diagnosing an extra-axial chordoma of the proximal tibia with the help of brachyury, a molecule required for notochordal differentiation. Skeletal Radiol. 2007;36(1):59-65.

(7.) van Diest PJ, van Dam P, Henzen-Logmans SC, et al. A scoring system for immunohistochemical staining: consensus report of the task force for basic research of the EORTC-GCCG: European Organization for Research and Treatment of Cancer-Gynaecological Cancer Cooperative Group. J Clin Pathol. 1997;50(10):801-804.

(8.) Mirra JM, Della Rocca C, Nelson SD, Mertens F. Chordoma. In: Fletcher CDM, Unni K, Mertens F, eds. Pathology and Genetics of Tumours of Soft Tissue and Bone. Lyon, France: IARC Press; 2002:316-317. World Health Organization Classification of Tumours.

(9.) Bergh P, Kindblom LG, Gunterberg B, Remotti B, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000;88(6):2122-2134.

(10.) Benjamin H, Gunnlaugur N, Norebet JL, Rosenberg A. Base of skull chordomas in children and adolescents: a clinicopathologic study of 73 cases. Am J Surg Pathol. 2006;30(7):811-818.

(11.) Coindre JM, Rivel J, Trojani M, De Mascarel I, De Mascarel A. Immunohistological study in chordomas. J Pathol. 1986;150(1):61-63.

(12.) Naka T, Iwamoto Y, Shinohara N, Chuman H, Fukui M, Tsuneyoshi M. Cytokeratin sub typing in chordomas and the fetal notochord: an immunohistochemical analysis of aberrant expression. Mod Pathol. 1997;10(6):545 551.

(13.) Rekhi B, Gorad BD, Chinoy RF. Clinicopathological features with outcomes of a series of conventional and proximal-type epithelioid sarcomas, diagnosed over a period of 10 years at a tertiary cancer hospital in India. Virchows Arch. 2008;453(2):141-153.

(14.) Soderstrom M, Bohling T, Ekfors T, Nelimarkka L, Aro HT, Vuorio E. Molecular profiling of human chondrosarcomas for matrix production and cancer markers. Int J Cancer. 2002;100(2):144-151.

(15.) Rozeman LB, Hameetman L, van Wezel T, et al. cDNA expression profiling of chondrosarcomas: Ollier disease resembles solitary tumours and alteration in genes coding for components of energy metabolism occurs with increasing grade. J Pathol. 2005;207(1):61-71.

(16.) Showell C, Binder O, Conlon FL. T-box genes in early embryogenesis. Dev Dyn. 2004;229(1):201-218.

(17.) Oakley GJ, Fuhrer K, Seethala RR. Brachyury, SOX-9 and podoplanin, new markers in the skull based chordomas vs chondrosarcoma differential: a tissue microarray based comparative analysis. Mod Pathol. 2008;21(12):1461-1469.

(18.) Fischer C. Parachordoma exists--but what is it? Adv Anat Pathol. 2000; 7(3):141-148.

(19.) Crockard HA, Steel T, Plowman N, et al. A multidisciplinary team approach to skull base chordomas. J Neurosurg. 2001;95(2):175-182.

(20.) Heffelfinger MJ, Dahlin DC, MacCarty CS, Beabout JW. Chordomas and cartilaginous tumors at the skull base. Cancer. 1973;32(2):410-420.

Nirmala A. Jambhekar, MD; Bharat Rekhi, MD, DNB, MIAC; Kiran Thorat, MD; Rajesh Dikshit, PhD; Manish Agrawal, MS, DNB; Ajay Puri, MS

Accepted for publication October 22, 2009.

From the Departments of Pathology (Drs Jambhekar, Rekhi, and Thorat), Epidemiology and Biostatistics (Dr Dikshit), and Orthopedic Surgical Oncology (Drs Agrawal and Puri), Tata Memorial Hospital, Parel, Mumbai, India.

The authors have no relevant financial interest in the products or companies described in this article.

Presented in part at the annual meeting of the United States and Canadian Academy of Pathologists, Boston, Massachusetts, March 713, 2009.

Reprints: Bharat Rekhi, MD, DNB, MIAC, Department of Pathology, 8th Floor Annexe Building, Tata Memorial Hospital, Dr E. B. Road, Parel, Mumbai 400 012, India (e-mail: rekhi.bharat@gmail.com).
Table 1. Clinicopathologic Features and Immunohistochemical Results of
51 Axial Chordomas

Case Age, Size,
No. y/Sex Site Specimen cm Type

1 38/F SC SB 10.4 Ch
2 30/M SC WE 8 Cl
3 53/M BS B NA Cc
4 64/M SC WE 9 Cc
5 28/M SC WE 14 Cc
6 30/F BS SB 7.3 Cc
7 41/M SC B NA Cl
8 42/M BS SB NA Cl
9 49/M CS SB NA Cc
10 42/M SC SB NA Cl
11 58/M SC SB NA Cl
12 60/M SC ME 10 Cl
13 53/F BS SB NA Cl
14 60/M SC WE 12 Cl
15 49/M SC SB NA Cl
16 70/M CS B 8 Cl
17 55/M SC WE NA Cl
18 69/F SC SB NA Cl
19 22/F BS B NA Cc
20 62/M SC SB 14 Cl
21 63/M SC SB NA Cl
22 60/F SC B NA Cl
23 78/M SC B NA Cl
24 61/M SC B 12 Cl
25 63/M SC SB NA Cl
26 53/M SC SB NA Cl
27 45/F SC WE 14 Cl
28 74/M LS SB NA Cl
29 45/M BS SB NA Cc
30 70/F S SB NA Cc
31 50/F BS SB NA Ch
32 44/M BS WE 6 Cc
33 78/M SC B NA Cl
34 27/M SC B 8.7 Cl
35 53/M SC WE NA Cl
36 40/F CS SB NA Cl
37 54/F CS ICE 10.1 Cl
38 40/F SC B 17 Cl
39 40/F SC SB NA Cc
40 67/M SC B 11 Cl
41 55/M CS B NA Cl
42 59/M SC ME 11.5 DC
43 49/M SC ME 9 Cc
44 68/M S SB NA Cl
45 48/M SC WE 16 Cc
46 65/M SC SB NA Cl
47 62/M SC SB NA DC
48 55/M TS B 4 Cc
49 56/M SC WE NA Cl
50 69/F SC WE 8 Cl
51 50/F SC SB NA Cl

 Immunohistochemical Results
Case
No. CK EMA S100 Vimentin BU

1 P P P ND P
2 ND ND ND ND P
3 ND ND ND ND P
4 P P P P P
5 P P P ND P
6 ND ND ND ND P
7 ND ND ND ND P
8 P P P P P
9 P P P ND P
10 P P ND P P
11 ND ND ND ND P
12 P P P ND P
13 ND ND ND ND P
14 ND ND ND ND P
15 ND ND ND ND P
16 ND ND ND ND P
17 ND ND ND ND P
18 P P P P P
19 ND ND ND ND N
20 P P P ND P
21 ND ND ND ND P
22 P P P P P
23 ND ND ND ND P
24 ND ND ND ND P
25 ND ND ND ND N
26 ND ND ND ND N
27 ND ND ND ND P
28 ND ND ND ND P
29 ND ND ND ND P
30 ND ND ND ND P
31 P P P ND P
32 ND ND ND ND P
33 ND ND ND ND N
34 ND ND ND ND P
35 ND ND ND ND P
36 ND ND ND ND P
37 P ND P ND N
38 P P P ND P
39 P P ND ND P
40 P P N P P
41 P P N ND P
42 P P N P P
43 P P P ND P
44 P P P P P
45 P P P ND P
46 P P P P P
47 P P P P P
48 P P P ND P
49 ND ND ND ND P
50 ND ND ND ND P
51 ND ND ND ND P

 Recurrence
Case and/or
No. Treatment Margins Metastasis

1 NK -- --
2 NACT R0 Rec and
 + NART Mets
 + Surgery
3 NK -- --
4 Surgery R0 Rec
5 Surgery R0 --
6 NK -- --
7 NK -- --
8 NK -- --
9 NK -- --
10 NK -- --
11 NK -- --
12 Surgery R1 --
 + RT
13 NK -- --
14 Surgery R0 Rec
15 NK -- --
16 Surgery Rx Rec
17 Surgery R0 Rec and
 Mets
18 NK -- --
19 NK -- --
20 NK -- --
21 NK -- --
22 NK -- --
23 NK -- --
24 Palliative RT -- --
25 NK -- --
26 NK -- --
27 Surgery R0 --
28 NK -- --
29 NK -- --
30 NK -- --
31 NK -- --
32 Surgery R0 --
33 Surgery Rx --
34 NK -- --
35 Surgery R0 --
36 NK -- --
37 Surgery R2 --
38 NK -- --
39 NK -- --
40 NK -- --
41 NK -- --
42 Surgery R1 --
43 Surgery R1 --
44 NK -- --
45 Surgery R0 Rec
46 NK -- --
47 NK -- --
48 Surgery Rx --
49 Surgery R0 Rec
50 Surgery R0 --
51 NK -- --

Abbreviations: B, biopsy; BS, base of skull; BU, brachyury; Cc,
classical with a chondroid component; Ch, chondroid chordoma; CK,
cytokeratin; Cl, classical chordoma; CS, cervical spine; DC,
dedifferentiated chordoma; EMA, epithelial membrane antigen; ICE,
intracapsular excision; LS, lumbar spine; ME, marginal excision; Mets,
metastasis; N, negative; NA, not available; NACT, neoadjuvant
chemotherapy; NART, neoadjuvant radiotherapy; ND, not done; NK, not
known; P, positive; R0, wide excision with gross and microscopically
free margins; R1, marginal excision with grossly negative and
microscopically positive margins; R2, intracapsular excision with
grossly and microscopically positive margins; Rec, recurrence; RT,
radiotherapy; Rx, unavailable marginal status; S, spine (not
specified); SB, slides and blocks; SC, sacrococcyx; TS, thoracic
spine; WE, wide excision.

Table 2. Summary of 58 Nonchordomatous Tumors Also Evaluated for
Brachyury Expression

Case Age,
No. y/Sex Site Tumor (a)

1 18/F Maxilla Mucoepidermoid carcinoma
2 37/M Parotid Pleomorphic adenoma
3 25/F Parotid Mucoepidermoid carcinoma
4 50/M Parotid Pleomorphic adenoma
5 43/F Parotid Pleomorphic adenoma
6 72/F Parotid Mucoepidermoid carcinoma
7 18/F Maxilla Mucoepidermoid carcinoma
8 33/F Parotid Pleomorphic adenoma
9 42/M Tibia Chondrosarcoma (III)
10 55/M Ilium Chondrosarcoma (I)
11 21/F Ilium Chondrosarcoma (I)
12 52/F Femur Chondrosarcoma (II)
13 48/F Ilium Chondrosarcoma (II)
14 62/M Scapula Chondrosarcoma (II)
15 45/M Femur Chondrosarcoma (II)
16 38/F Ilium Chondrosarcoma (II)
17 55/M Tibia Chondrosarcoma (II)
18 36/M Ilium Chondrosarcoma (II)
19 44/M Ilium Chondrosarcoma (II)
20 42/F Tibia Chondrosarcoma (II)
21 57/M Rib Chondrosarcoma (I)
22 39/M Ilium Chondrosarcoma (I)
23 45/M Ilium Chondrosarcoma (III)
24 37/M Sternum Chondrosarcoma (III)
25 53/M Femur Chondrosarcoma (III)
26 51/M Knee Extraskeletal myxoid chondrosarcoma
27 54/M Supraspinatus Extraskeletal myxoid chondrosarcoma
28 22/F Sacroiliac Chondromyxoid fibroma
29 15/M Tibia Chondromyxoid fibroma
30 17/M Femur Chondroblastoma
31 14/M Scapula Osteochondroma
32 14/F Fibula Osteochondroma
33 12/M Scapula Osteochondroma
34 18/F Tibia Osteochondroma
35 24/M Thigh Myxoid liposarcoma
36 68/M Neck Myxoid liposarcoma
37 47/M Mediastinum Pleomorphic liposarcoma
38 70/M Thigh Myxoid liposarcoma
39 48/M Intraabdominal Dedifferentiated liposarcoma (MFS)
40 55/M Arm Pleomorphic sarcoma
41 48/M Arm Myxoid liposarcoma
42 55/M Kidney Renal cell carcinoma
43 62/M Kidney Renal cell carcinoma
44 6/F Leg Rhabdomyosarcoma
45 7/M Foot Rhabdomyosarcoma
46 2/M Orbit Rhabdomyosarcoma
47 23/M Intranasal tumor Rhabdomyosarcoma
48 26/F Arm Rhabdomyosarcoma
49 22/M Testis Seminoma
50 32/M Testis Seminoma
51 49/M Testis Mixed germ cell tumor
52 26/M Testis Teratoma and yolk sac tumor
53 35/M Testis Seminoma
54 44/M Testis Seminoma
55 42/M Colon Mucinous adenocarcinoma
56 63/M Rectum Mucinous adenocarcinoma
57 57/M Ovary Mucinous adenocarcinoma
58 47/F Nasopharynx Sinonasal teratocarcinoma

Abbreviation: MFS, myxofibrosarcoma component.

(a) Grade of chondrosarcoma specified in parenthesis.
COPYRIGHT 2010 College of American Pathologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2010 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Jambhekar, Nirmala A.; Rekhi, Bharat; Thorat, Kiran; Dikshit, Rajesh; Agrawal, Manish; Puri, Ajay
Publication:Archives of Pathology & Laboratory Medicine
Date:Aug 1, 2010
Words:4151
Previous Article:Solid variant of papillary renal cell carcinoma with spindle cell and tubular components.
Next Article:Significance of high-risk human papillomavirus DNA detection in women 50 years and older with squamous cell Papanicolaou test abnormalities.
Topics:

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters