Shruti Agrawal, Baptiste Ameline, Andrew L Folpe, Elizabeth Azzato, Caroline Astbury, Thomas Mentzel, Calvin Knapp, Arno Rütten, David Creytens, William Sukov, Daniel Baumhoer, Steven D Billings, Karen J Fritchie
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NGS-naïve or <i>PDGFB</i>-negative DFSP were screened for ALK (clone D5F3) expression by immunohistochemistry. NGS or <i>ALK</i> FISH was performed on ALK-positive cases. Methylome profiling studies were performed and compared with conventional DFSP. One case of “DFSP” and two “P-LDF” with ALK expression were identified from the archives, while four cases were detected prospectively. These seven cases (6F:1M; 8 months to 76 years) arose in the dermis of the arm (two), scalp, eyelid, thigh, abdomen, and shoulder and ranged from 0.4 to 4.2 cm. Tumours were composed of spindled cells and displayed a storiform growth pattern. Cytologic atypia was absent, and mitotic figures were scarce (0–2/10 HPFs, high power fields). The lesional cells were diffusely positive for CD34 and ALK and negative for S100 protein. By NGS (<i>n</i> = 5), <i>ALK</i> fusion partners included <i>DCTN1</i> (2), <i>PLEKHH2</i>, and <i>CLIP2</i> in DFSP-like cases and <i>FLNA</i> in P-LDF-like lesions. <i>ALK</i> FISH was positive in one (of two) cases previously labelled P-LDF. Methylome profiling of two (of three) <i>ALK</i>-rearranged DFSP-like tumours showed clustering with conventional DFSP in the UMAP dimension reduction plot. To date, no tumour has recurred (<i>n</i> = 2; 26, 27 months).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>We describe a cohort of novel <i>ALK</i>-rearranged tumours with morphologic features similar to DFSP.</p>\n </section>\n </div>","PeriodicalId":13219,"journal":{"name":"Histopathology","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/his.15239","citationCount":"0","resultStr":"{\"title\":\"ALK-rearranged, CD34-positive spindle cell neoplasms resembling dermatofibrosarcoma protuberans: a study of seven cases\",\"authors\":\"Shruti Agrawal, Baptiste Ameline, Andrew L Folpe, Elizabeth Azzato, Caroline Astbury, Thomas Mentzel, Calvin Knapp, Arno Rütten, David Creytens, William Sukov, Daniel Baumhoer, Steven D Billings, Karen J Fritchie\",\"doi\":\"10.1111/his.15239\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>The majority of dermatofibrosarcoma protuberans (DFSP) harbour <i>PDGFB</i> or <i>PDGFD</i> rearrangements. We encountered ALK expression/rearrangement in a <i>PDGFB/D</i>-negative CD34-positive spindle cell neoplasm with features similar to DFSP, prompting evaluation of <i>ALK</i>-rearrangements in DFSP and plaque-like CD34-positive dermal fibroma (P-LDF).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods and Results</h3>\\n \\n <p>We searched the archives of academic institutions for cases previously coded as DFSP and P-LDF. NGS-naïve or <i>PDGFB</i>-negative DFSP were screened for ALK (clone D5F3) expression by immunohistochemistry. NGS or <i>ALK</i> FISH was performed on ALK-positive cases. Methylome profiling studies were performed and compared with conventional DFSP. One case of “DFSP” and two “P-LDF” with ALK expression were identified from the archives, while four cases were detected prospectively. These seven cases (6F:1M; 8 months to 76 years) arose in the dermis of the arm (two), scalp, eyelid, thigh, abdomen, and shoulder and ranged from 0.4 to 4.2 cm. Tumours were composed of spindled cells and displayed a storiform growth pattern. Cytologic atypia was absent, and mitotic figures were scarce (0–2/10 HPFs, high power fields). The lesional cells were diffusely positive for CD34 and ALK and negative for S100 protein. By NGS (<i>n</i> = 5), <i>ALK</i> fusion partners included <i>DCTN1</i> (2), <i>PLEKHH2</i>, and <i>CLIP2</i> in DFSP-like cases and <i>FLNA</i> in P-LDF-like lesions. <i>ALK</i> FISH was positive in one (of two) cases previously labelled P-LDF. Methylome profiling of two (of three) <i>ALK</i>-rearranged DFSP-like tumours showed clustering with conventional DFSP in the UMAP dimension reduction plot. 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ALK-rearranged, CD34-positive spindle cell neoplasms resembling dermatofibrosarcoma protuberans: a study of seven cases
Aims
The majority of dermatofibrosarcoma protuberans (DFSP) harbour PDGFB or PDGFD rearrangements. We encountered ALK expression/rearrangement in a PDGFB/D-negative CD34-positive spindle cell neoplasm with features similar to DFSP, prompting evaluation of ALK-rearrangements in DFSP and plaque-like CD34-positive dermal fibroma (P-LDF).
Methods and Results
We searched the archives of academic institutions for cases previously coded as DFSP and P-LDF. NGS-naïve or PDGFB-negative DFSP were screened for ALK (clone D5F3) expression by immunohistochemistry. NGS or ALK FISH was performed on ALK-positive cases. Methylome profiling studies were performed and compared with conventional DFSP. One case of “DFSP” and two “P-LDF” with ALK expression were identified from the archives, while four cases were detected prospectively. These seven cases (6F:1M; 8 months to 76 years) arose in the dermis of the arm (two), scalp, eyelid, thigh, abdomen, and shoulder and ranged from 0.4 to 4.2 cm. Tumours were composed of spindled cells and displayed a storiform growth pattern. Cytologic atypia was absent, and mitotic figures were scarce (0–2/10 HPFs, high power fields). The lesional cells were diffusely positive for CD34 and ALK and negative for S100 protein. By NGS (n = 5), ALK fusion partners included DCTN1 (2), PLEKHH2, and CLIP2 in DFSP-like cases and FLNA in P-LDF-like lesions. ALK FISH was positive in one (of two) cases previously labelled P-LDF. Methylome profiling of two (of three) ALK-rearranged DFSP-like tumours showed clustering with conventional DFSP in the UMAP dimension reduction plot. To date, no tumour has recurred (n = 2; 26, 27 months).
Conclusion
We describe a cohort of novel ALK-rearranged tumours with morphologic features similar to DFSP.
期刊介绍：
Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.
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