Clear cell sarcoma of the pancreas,an unusual cancer with unusual metastatic site or unusual primary site?

Clear cell sarcoma(CCS)is a type of malignant tumor that can arise from tendons and aponeuroses.This malignant proliferation of cells with melanocytic lineage normally occurs in young patients,and it is normally identified in extremities.However,different sites including gastrointestinal organs are also described.Due difficulties in the molecular and histopathology evaluation,the diagnosis is often confused with malignant melanoma.Most cases are treated with surgical resection,but overall,the prognosis is poor.In this editorial,we will discuss a very interesting case of CCS identified in the pancreas.We will discuss the literature and controversies in the management of this type of cancer.Furthermore,we will address molecular strategies to be incorporated in those cases to better understand the primary location of the tumor.Finally,future perspectives of the field and new strategies of treatment will be described.

Clear cell sarcoma metastasizing to the pancreas

In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to the lungs,bones,and brain,clear cell sarcoma rarely extends its reach to the pancreas.Despite the initial absence of discernible abnormalities during the patient's physical examination,the manifestation of abdominal pain prompted further investigation.Subsequent abdominal computed tomography brought to light the presence of a pancreatic tumor,culminating in the definitive diagnosis of clear cell sarcoma with pancreatic metastasis.The successful management of this atypical presentation involved a series of surgical interventions,including distal pancreatectomy and splenectomy.This report not only sheds light on the infrequent manifestation of clear cell sarcoma within the pancreas but also underscores the pivotal role of vigilant postoperative follow-up in addressing this rare sarcoma.The emphasis on postoperative care serves as a crucial aspect of the broader narrative,acknowledging the need for ongoing monitoring and management to ensure a comprehensive and successful treatment trajectory for patients with this unique presentation of clear cell sarcoma.

Metastatic clear cell sarcoma of the pancreas:A rare case report

BACKGROUND Clear cell sarcoma(CCS)is a rare soft-tissue sarcoma.The most common metastatic sites for CCS are the lungs,bones and brain.CCS is highly invasive and mainly metastasizes to the lung,followed by the bone and brain;however,pancreatic metastasis is relatively rare.CASE SUMMARY We report on a rare case of CCS with pancreatic metastasis in a 47-year-old man.The patient had a relevant medical history 3 years ago,with abdominal pain as the main clinical manifestation.No abnormalities were observed on physical examination and the tumor was found on abdominal computed tomography.Based on the medical history and postoperative pathology,the patient was diagnosed with CCS with pancreatic metastasis.The patient was successfully treated with surgical interventions,including distal pancreatectomy and sple-nectomy.CONCLUSION This report summarizes the available treatment modalities for CCS and the importance of regular postoperative follow-up for patients with CCS.

Metastatic clear cell sarcoma of the pancreas:A sporadic cancer

Primary or secondary clear cell sarcoma of the pancreas is an exceedingly rare and aggressive disease.In addition to pathology,molecular analysis is pivotal in differential diagnosis,especially with malignant melanoma.A key aspect in identifying clear cell sarcoma is specific genetic alterations,notably the translocation of t(12;22)(q13;q13),a diagnostic hallmark of this sarcoma subtype,which is absent in malignant melanoma.Treatment of primary clear cell sarcoma of the pancreas is the same as that for adenocarcinoma.

Shedding light on pancreatic metastasis of clear cell sarcoma:An exceptional journey

This editorial comments on the study by Liu et al investigating pancreatic metastasis of clear cell sarcoma(CCS)published in the World Journal of Clinical Cases.CCS is a rare and aggressive melanocytic tumor,that typically arises from tendons and aponeuroses of the limbs,and metastasizes to the lungs,bones,and brain.However,pancreatic metastasis has rarely been reported,presenting unique diagnostic and therapeutic challenges.Elucidating the clinical characteristics,imaging features,prognostic factors,and treatment outcomes of patients with pancreatic CCS metastasis is crucial.Surgery remains an effective management strategy for CCS.However,the high recurrence rate and low effectiveness of traditional adjuvant treatments necessitate a shift towards more personalized and targeted treatment plans.Research is needed to investigate and validate novel therapeutic approaches specifically tailored to the distinct genetic and molecular characteristics of rare malignancies like CCS.Additionally,the development of late metastases after a long disease-free interval is common in CCS patients.Therefore,routine postoperative surveillance for metastasis using computed tomography,magnetic resonance imaging,bone scans,and positron emission tomography scans is crucial.Moving forward,enhanced collaboration,investigation,and creative thinking among scientists,medical professionals,and legislators are essential to gain a deeper understanding of these rare presentations.

Metastatic clear cell sarcoma of the pancreas:An overview

Clear cell sarcoma(CCS)is a rare soft-tissue sarcoma that accounts for less than 1%of all cases and was originally reported in 1965.The incidence of CCS is estimated to be approximately 0.014/100000 depending on the surveillance,epidemiology and end results databases.CCS is a highly invasive type that mainly metastasizes to the lungs,followed by the bones and brain;however,pancreatic metastasis is relatively rare.It has a high probability of recurrence or metastasis and has a poor prognosis with a high mortality rate.Finally,even after recovery,it is fundamental to keep regular postoperative follow-up for CCS patients.

Metastatic clear cell sarcoma of the pancreas:From diagnosis to treatment

This article presents a comprehensive case report on an uncommon instance of metastatic clear cell sarcoma(CCS)originating from the pancreas.The high mortality rate of pancreatic carcinoma underscores the importance of precise diagnosis and early detection.The authors report a novel case of CCS with pancreatic metastasis,detailing successful surgical intervention through distal pancreatectomy and splenectomy,resulting in favourable outcomes.This study highlights the standard role of surgery in treating advanced CCS and emphasizes preoperative imaging and thorough patient history assessment.This article also underscores the necessity for long-term surveillance due to the potential for recurrence or metastasis.Despite the favourable recovery postsurgery,the absence of subsequent follow-up evaluation prompts consideration of the need for extended monitoring.This article raises questions about the nature of the pancreatic lesion and suggests the possibility of a primary lesion.Further evidence is crucial to establish the correlation between the features related to the development of the patient's primary and metastatic tumours.In conclusion,this study offers valuable insights into metastatic CCS of the pancreas,highlighting the importance of regular postoperative follow-up for improved outcomes through early detection and intervention.

Medical imaging for the diagnosis,recurrence and metastasis evaluation of clear cell sarcoma

Clear cell sarcoma(CCS)of soft tissue is extremely rare,accounting for approximately 1%of all soft tissue tumours.It is very difficult to diagnose CCS based on clinical manifestations.Magnetic resonance imaging(MRI)provides highresolution images of soft tissues and pathological features such as mucus,necrosis,bleeding,and fat through high and low signals on T1 weighted image(T1WI)and T2 weighted image(T2WI).On the other hand,the paramagnetism of melanin in CCS shortens the relaxation time of T1 and T2,and high signal intensity on T1WI and low signal intensity on T2WI can be found.This is different from most other soft tissue sarcomas.At present,the treatment method for CCS is surgical resection.MRI can effectively display the tumour edge,extent of surrounding oedema,and extent of fat involvement,which is highly important for guiding surgical resection and predicting postoperative recurrence.As an invasive sarcoma,CCS has a high risk of metastasis.Regardless of the pathological condition of the resected tumour,MRI or computed tomography(CT)should be performed every 1-2 years to assess recurrence at the primary site and to screen for metastasis in the lungs,liver,and bones.If necessary,PET-CT can be performed to evaluate the overall condition of the patient.

Malignant melanoma:An important differential diagnosis for clear cell sarcoma of the gastrointestinal tract

A case report by Liu et al describes the characteristics of metastatic clear cell sarcoma(CCS)of the pancreas and provides valuable therapeutic insights for this rare malignancy.This case is interesting because of its rarity,suggesting that the pancreas may be a potential target organ for CCS,either primary or metastatic.At the same time,the authors also emphasize the importance of regular postoperative follow-up for timely detection of recurrent lesions,as CCS is characterized by a high degree of malignancy and a high rate of recurrent metastases.Considering that CCS of the gastrointestinal tract is easily confused with malignant melanoma(MM)of the gastrointestinal tract,here we compare the clinical features,histopathological and immunohistochemical characteristics,diagnosis,treatment,and prognosis of CCS and MM of the gastrointestinal tract,hoping to provide a reference for clinical work.

Clear Cell Pleomorphic Dermal Sarcoma: A Case Report and Literature Review

Introduction: Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are one spectrum of rare cutaneous neoplasms that typically arise in sun-exposed skin of older population. AFX/PDS is essentially diagnosis of exclusion requiring Immunohistochemical work-up to exclude other types of tumors. Case Report: We present a case involving an ulcerated solitary lesion on the scalp of an elderly man. Histological examination revealed that the dermal tumor was composed of large pleomorphic, epithelioid, and spindle cells with clear cytoplasm. These cells were negative for cytokeratins, melanocytes and smooth muscle markers, but positive for CD10. These findings are consistent with a diagnosis of clear cell (CC) PDS. Conclusion: PDS is a low-grade malignancy that can recur locally and metastasize, which is distinguished from AFX by its larger size and the presence of aggressive histopathologic features including deeper invasion into the subcutaneous tissue, tumor necrosis, and lymphovascular and/or perineural involvement. Among several histopathologic variants, the CC variant is extremely rare with only two cases of PDS reported in the literature to date.

Essential role of postoperative follow-up in the management of clear cell sarcoma

Clear cell sarcoma(CCS)is a rare melanocytic soft tissue sarcoma known for itspropensity to metastasize to the lymph nodes and typically has an unfavorableprognosis.Currently,surgical resection is the primary treatment for localizedCCS,while radiotherapy and chemotherapy are preferred for metastatic cases.The roles of adjuvant chemotherapy,radiotherapy,and lymph node dissection arecontroversial.Although immunotherapy has emerged as a promising avenue inCCS treatment research,there are no established clinical standards for postoperativefollow-up.This editorial discusses a recent article by Liu et al,with afocus on current diagnostic modalities,treatment approaches,and the challengingprognosis associated with CCS.Our aim is to underscore the importance of longtermpatient follow-up in CCS management.

CLEAR CELL CHONDROSARCOMA OF BONE (A REPORT OF THREE CASES WITH IMMUNOHISTOCHEMICAL AND AFFINITY HISTOCHEMICAL OBSERVATIONS)

Clear cell chondrosarcoma, a subtype and separate entity from the traditional chondrosarcoma, is characterized by its special histologic features, site of predilection, slow growth and better prognosis. Three cases are presented with elucidation of clinicopathologic correlation and detection by the ABC immunohistochemical method using several antibodies. The observation of positive reaction to S-100 pretein (S-100), vimentin(Vim), alpha 1-antichymotrypsin (AACT) and lysozyme (Lyso) by the tumor cells of clear cell chondrosarcoma, similar to traditional chondrosarcoma and chondroblastoma, proves that this tumor has its origin from the cartilaginous tissue. It was found for the first time that the clear cell chondrosarcoma was positive for wheat germ agglutinin (WGA) and concanavalin A (Con A). The authors believe that clear cell chondrosarcoma may result from the anaplastic changes of chondroblastoma cells Into another subtype of that tumor. The osteoclast-like multinucleated giant cells (MGC), retaining the antigens of phagocytes, are not considered to be neoplastic.

Analysis of Sentinel Lymph Node Biopsy on Clear Cell Sarcoma Treatment

Clear Cell Sarcoma (CCS) is a rare soft tissue sarcoma that corresponds to a less than 1% of all sarcomas and is a high degree neoplasm with propensity to disseminate to regional lymph nodes. Regional lymphadenectomies have a controversial impact on sarcomas treatment and survival, even though those patients have higher local recurrence and lower survival. So, sentinel lymph node biopsy must be one option for better regional staging to STS with higher propensity to lymph node commitment. The authors demonstrate two cases of CCS submitted to surgery through compartmental resection associated with the sentinel lymph node biopsy. A literature review about soft tissue sarcoma and lymph node sentinel biopsy is shown as an initial experience of two cases.

Paraplegia after transcatheter artery chemoembolization in a child with clear cell sarcoma of the kidney:A case report

BACKGROUND Transcatheter arterial chemoembolization(TACE)is a common treatment for inoperable malignant renal tumors.However,a series of complications may follow the TACE treatment.Spinal cord injury caused by the embolization of intercostal or lumbar arteries is extremely rare.CASE SUMMARY We describe a case with quite uncommon spinal cord injury after TACE in a 3-year-old child with clear cell sarcoma of the kidney.Sensory impairment beneath the T10 dermatomes and paraplegia on the day after TACE were found in this patient.Unfortunately,sustained paraplegia still existed for more than 2 mo after TACE despite the large dose of steroids and supportive therapy.CONCLUSION We should draw attention to an uncommon complication of paraplegia after TACE treatment in malignant renal tumors.Although it is rare,the result is disastrous.

Primary clear cell sarcoma of soft tissue in the posterior cervical spine invading the medulla oblongata:A case report

BACKGROUND Clear cell sarcoma(CCS)is a rare and highly malignant soft tissue tumor,usually occurring in the deep soft tissues of the distal tendons and aponeurosis of the extremities,especially the feet and knees.CCS originating in the head and neck is extremely rare.The clinical manifestations of CCS in the head and neck are not typical,and the imaging manifestations have certain characteristics,but the diagnosis still depends on pathological examination and genetic testing.CASE SUMMARY A 33-year-old male patient had paroxysmal headache for more than 4 years,accompanied by nausea and vomiting,which could be relieved after rest.Computed tomography angiography showed a left paraspinal soft tissue mass.Contrast-enhanced imaging showed obvious uneven enhancement with adjacent bone lytic destruction.Magnetic resonance imaging examination showed isosignal on T_(1)-weighted images,slightly high signal on T_(2)-weighted images(T_(2)WI),high signal on Tirm fat suppression sequence,significantly high signal on diffusion weighted imaging,and obvious and uneven enhancement.The lesion invaded the anterior medulla oblongata through the left atlantoaxial foramen and compressed the cervical spinal cord on T_(2)WI.Primary CCS of soft tissue was diagnosed by pathology and genetic examination.CONCLUSION CCS should be considered in the differential diagnosis of soft tissue tumors of the head and neck,and their diagnosis depends on pathological examination and genetic testing.

Clear Cell Sarcoma of the Kidney-A Case Report

Clear cell sarcoma of the kidney （CCSK） is a rare and highly malignant tumor which is usually confused with other kidaey tumors We experienced such a patient and present report this.

Postoperative multiple metastasis of clear cell sarcoma-like tumor of the gastrointestinal tract in adolescent:A case report

BACKGROUND Clear cell sarcoma-like tumor of the gastrointestinal tract(CCSLGT)is a rare malignant gastrointestinal mesenchymal soft tissue tumor.Its genetic feature is EWSR1 gene rearrangement.Histologically,it is often accompanied by a varying number of CD68-positive osteoclast-like giant cells.CCSLGT mostly occurs in the small intestinal wall of young people and children.In terms of clinical manifestations,there is no significant difference between it and other gastrointestinal tumors,and the diagnosis depends on immunohistochemistry and gene detection.CASE SUMMARY A 16-year-old man developed dizziness and fatigue 2 mo ago,and 10 d ago showed progressive exacerbation of paroxysmal epigastric pain and stopped flatulence and defecation.Computed tomography showed a soft tissue mass in the distal ileum.After complete resection of the lesion,it was diagnosed by combined immunohistochemical and genetic examination as CCSLGT.After surgery,the patient gradually developed lymph node,liver,lung,bone,left thigh,pleura and adrenal metastasis.The survival time was 4 years and 8 mo.CONCLUSION Whole abdominal computed tomography enhancement is recommended for patients with gastrointestinal symptoms.There is no effective treatment for CCSLGT with multiple metastases via the lymphatic system and bloodstream after surgical resection.

Clear cell sarcoma of soft tissue in pleural cavity: A case report

BACKGROUND Clear cell sarcoma(CCS)of soft tissue is a rare malignant soft tissue sarcoma usually reported to locate at distal end of extremities and rarely at trunk.Herein,we report a case of CCS in pleural cavity.CASE SUMMARY A 31-year-old male was admitted for an uncertain mass in left pleural cavity in routine physical examination without any symptoms.A VATS surgery was performed to remove the tumor.The pathological finding displayed a cystic mass with 6.5 cm at the longest diameter,dark red in section and cysts could be found locally.A strong expression of S-100,HMB45 and Vimentin was detected in immunohistochemical staining,which was inclined to the diagnosis of the CCS of soft tissue.The patient refused chemotherapy,radiotherapy and targeted therapy because of the personal financial situation.Follow-up computed tomography scans were done at the 90th postoperative day and the 180th postoperative day,and no obvious sign of recurrence was found till now.CONCLUSION CCS of soft tissue also can be found in pleural cavity although in an extremely rare incidence.Radical resection is useful to improve the prognosis.

Clear cell sarcoma in unusual sites mimicking metastatic melanoma

BACKGROUND Clear cell sarcoma is an aggressive rare malignant neoplasm with morphologic and immunohistochemical similarities to malignant melanoma.Both disease entities display melanin pigment and melanocytic markers,making differentiation between the two difficult.Although clear cell sarcoma cases in the literature have mainly involved deep soft tissues of the extremities,trunk or limb girdles,we report here two cases of primary clear cell sarcoma in unusual sites and describe their clinicopathologic findings.CASE SUMMARY The first case involves a 37-year-old female,who presented with jaw pain and a submandibular mass.The second case involves a 33-year-old male,who presented with back pain and a thoracic spine tumor.Both cases showed tumors with diffuse infiltration of neoplastic cells that were positive for melanocytic markers,and in both cases this finding led to an initial diagnosis of metastatic melanoma.However,further analysis by fluorescence in situ hybridization(commonly known as FISH)showed a rearrangement of the EWS RNA binding protein 1(EWSR1)gene on chromosome 22q12 in both patients,confirming the diagnosis of clear cell sarcoma.CONCLUSION Distinction between clear cell sarcoma and malignant melanoma can be made by FISH,particularly in cases of unusual tumor sites.

Clear cell sarcoma of the jejunum—Surgical management in two patients with review of the literature

Clear cell sarcoma is usually described as a malignant melanoma of the soft tissues. The overall prognosis is poor because of delay in diagnosis and vague clinical symptoms. It is rarely involved in the gastrointestinal tract, and its diagnosis is often missed secondary to infrequent occurrence and histological resemblance to melanoma. We present two cases of primary CCS of the jejunum whose clinical presentations were complicated by lymph node involvement. Prompt diagnosis and potential aggressive surgical intervention may improve overall survival.