Metastatic Pediatric Sclerosing Epithelioid Fibrosarcoma

Sclerosing epithelioid fibrosarcoma (SEF) is a rare and aggressive soft tissue sarcoma thought to originate in fibroblasts of the tissues comprising tendons, ligaments and muscles. Minimally responsive to conventional cytotoxic chemotherapies, greater than 50% of SEF patients experience local recurrence and/or metastatic disease. SEF is most commonly discovered in middle-aged and elderly adults, but also rarely in children. A common gene fusion occurring between the EWSR1 and CREB3L1 genes has been observed in 80-90% of SEF cases. We describe here the youngest SEF patient reported to date (a 3-year-old Caucasian male) who presented with numerous bony and lung metastases. Additionally, we perform a comprehensive literature review of all SEF-related articles published since the disease was first characterized. Finally, we describe the generation of an SEF primary cell line, the first such culture to be reported. The patient described here experienced persistent disease progression despite aggressive treatment including multiple resections, radiotherapy and numerous chemotherapies and targeted therapeutics. Untreated and locally recurrent tumor and metastatic tissue were sequenced by whole genome, whole exome, and deep transcriptome next generation sequencing with comparison to a patient-matched normal blood sample. Consistent across all sequencing analyses was the disease-defining EWSR1-CREB3L1 fusion as a single feature consensus. We provide an analysis of our genomic findings and discuss potential therapeutic strategies for SEF.

Cold Spring Harb Mol Case Stud. 2021 Aug 6;mcs.a006093. doi: 10.1101/mcs.a006093.


Other Contributors

Andrew D Woods 1, Reshma Purohit 2, Laura Mitchell 3, John Collier 2, Katherine Collier 2, Melvin Lathara 4, Katrina Learned 5, Olena Vaske 5, Heather Geiger 6, Kazimierz O Wrzeszczynski 6, Vaidehi Jobanputra 6, Ganapati Srinivasa 4, Erin Rudzinski 7, Kimberly Whelan 3, Elizabeth Beierle 3, Sheri Spunt 8, Charles Keller 2, Aman Wadhwa 9

1Children’s Cancer Therapy Dev Inst.
2Children’s Cancer Therapy Development Institute.
3University of Alabama at Birmingham.
4Omics Data Automation.
5University of California Santa Cruz.
6New York Genome Center.
7Seattle Children’s Hospital.
8Stanford University School of Medicine.
9University of Alabama at Birmingham