Rare Primary Malignant Bone Sarcomas

Abstract

Rare primary malignant bone sarcomas (RPMBS), other than osteosarcoma, chondrosarcoma, chordoma, and Ewing sarcoma, account for about 5-10% of primary bone tumors and represent a major diagnostic challenge. These tumors include spindle cell and round cell sarcoma entities, hemangiopericytoma-like and vascular tumors. Additionally, several histotypes, traditionally described in the soft tissues, such as myxofibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor of bone, have been reported in patients with primary bone tumors. While wide surgical resection is the mainstay of local treatment, systemic therapy of these rare entities is controversial. Patients with undifferentiated spindle cell or pleomorphic high-grade tumors of bone, are usually treated with osteosarcoma-like chemotherapy, while patients with round cell and undifferentiated round cell tumors (URCTs), may respond to sarcoma treatment regimens for Ewing sarcoma patients. Studies on analogies and differences among these ultra-rare tumors have seldom been reported. This review describes relevance, clinical aspects, diagnostic procedures, staging, treatment recommendations, and current research in this composite tumor group.

Keywords: BCOR-CCNH3; CIC-DUX4; bone tumor; chemotherapy; molecular diagnostic; rare tumor; round cells sarcoma; sarcoma; spindle cells sarcoma; vascular sarcoma.

Figure 1

Diagnostic classification of rare primary malignant bone sarcoma. URCTs: undifferentiated round cells tumors; SFT: solitary fibrous tumor.

Figure 2

Histopathologic presentation of six cases of rare primary malignant bone sarcomas (A) spindle cell sarcoma of bone: tumor cells are typically organized in a fascicular or herringbone pattern; (B) angiosarcoma of bone: tumor is composed of a markedly atypical, predominantly solid epithelioid cell proliferation, featuring abundant eosinophilic cytoplasm, often harboring macronucleolated vescicular nuclei; (C–E) round cell sarcomas; (C) CIC-DUX4; (D) undifferentiated round cells sarcoma; (E) BCOR-CCNB3; (F) solitary fibrous tumor of bone with a classic hemangiopericytomatous pattern. (100× of magnification; haematoxylin and eosin staining).