Enterprise Interest No disclosures.

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1 Enterprise Interest No disclosures.

2 Secondary Tumours in Uropathology Case 2 PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

3 PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

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5 Prostatectomy Hx, 65y of age persistent rectal discomfort and PSA elevation (15 ng/ml) prostatic needle core biopsy acinar adenocarcinoma (Gleason score (GS) 4 + 4) in 10/11

6 Case 2 Histology acinar adenocarcinoma GS 4 + 5, 45% of prostate volume, pt3b pn0 (0/7) R0 Malignant mesenchymal tumour, spindle and pleomorphic cells IHC smooth muscle actin (1A4), desmin, CD34,PgR ER, S100 protein, cytokeratines (AE1/AE3 and 34betaE12)

7 Case 2: Spindle Cell Prostatic Metastasis Hx, 62y, 3 cm mass MCP3 joint of right hand 3 rd ray amputation PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

8 Courtesy of Dr. Nina Parafioriti

9 Courtesy of Dr. Nina Parafioriti

10 Courtesy of Dr. Nina Parafioriti

11 α-sma (1A4) MSA (HHF35) +ve (focal) CD 34, desmin, myogenin, HMB45, S100 protein, h-caldesmon, calponin, MITF, TFE3 -ive Courtesy of Dr. Nina Parafioriti

12 Case 2: Spindle Cell Prostatic Metastasis Hx, 62y, 3 cm mass MCP3 joint of right hand 3 rd ray amputation, UPS G3 Sarcoma Unit Former smoker Mitral valve plasty (@ 59y) Dilatative cardiomyopathy PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

13 Staging Chest CT scan: multiple bilateral lung nodules ranging from few mm up to 5 cm at chest CT Brain CT scan and MRi single cerebellar lesion, attached to the skull of 2 cm

14 Case 2: Spindle Cell Prostatic Metastasis Hx systemic treatment and radiation therapy for the brain metastasis. MDTB cardiac toxicity of Adriamycin Ifosfamide single agent After 6 cycles of chemotherapy and 7 months lung PR and cystic involution of the brain lesion. PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

15 Ifosfamide x6

16 Ifosfamide x6

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18 Case 2: Spindle Cell Prostatic Metastasis of age persistent rectal discomfort and PSA elevation (15 ng/ml) prostatic needle core biopsy PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

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21 Case 2: Spindle Cell Prostatic Metastasis of age persistent rectal discomfort and PSA elevation (15 ng/ml) prostatic needle core biopsy acinar adenocarcinoma (Gleason score (GS) 4 + 4) in 10/11 A single core PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

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26 α-sma (1A4) Desmin

27 S100 protein CK AE1/AE3/PCK26

28 PgR

29 Case 2: Spindle Cell Prostatic Metastasis Hx informed consent radical prostatectomy and regional node dissection acinar adenocarcinoma GS 4 + 5, 45% of prostate volume, pt3b pn0 (0/7) R0 associated with intraprostatic metastasis of UPS. PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

30 Case 2: Spindle Cell Prostatic Metastasis Hx total androgen blockade. Pt condition progressively worsened Multimodal therapy, with several lines of chemotherapy. The patient died at 66 years of age. PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

31 Case 2: Spindle Cell Prostatic Metastasis Discussion Primary Prostate Sarcoma (PPS): % of all the malignant prostatic tumours PPS in DDx Leyomiosarcoma (LMS) Rhabdomyosarcoma (RMS) Stromal Sarcoma PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

32 DDx1 Courtesy of Dr. M Colecchia

33 Courtesy of Dr. M Colecchia

34 least focally classic morphology: fascicles of spindle cells with a brightly eosinophilic cytoplasm and a vesicular, ovoid to cigar-shaped nucleus AND extensive positivity SMA or calponin, OR focal and strong positivity desmin or h-caldesmon! +ve CK (¼ of cases) progesterone receptor Courtesy of Dr. M Colecchia

35 DDx2

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38 DESMIN

39 MYOGENIN RMS Different subtypes (as in ST) Embrional Alveolar Pleomorphic positivity desmin and myogenin

40 DDx3

41 Stromal Sarcoma Younger age than STUMP positivity CD34 progesterone receptor

42 Test case

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44 What would you ask?

45 EMA

46 TLE1 Synovial Sarcoma (SS) M+ Hx of SS positivity EMA Bcl2 CD99 TLE1 SYT rearrangement

47 Case 2: Spindle Cell Prostatic Metastasis Conclusions Pt survived 5y after Dx Px of M+ STS is low STS can M+ to prostate Approaching a sarcoma Pt Hx review is essential To diagnose a M+ PPS should be ruled out PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD

48 Acknowledgements Patient and his family Dr Colombo for sharing the cases Dr Parafioriti and Dr Bertuzzi for the patient history Dr Colecchia for the LMS pics (numbers one and letters o ) PRESENTED AT: EUROPEAN CONGRESS OF PATHOLOGY 18 #ECP2018 Slides are the property of the author. Permission required for reuse. Presented by: SALVATORE L. RENNE MD