CIC-DUX sarcomas demonstrate frequent MYC amplification and ETS-family transcription factor expression

Steven Christopher Smith1, Darya Buehler2, Eun-Young Karen Choi3

  • 11] Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA [2] Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Insights

CIC-DUX sarcomas, a novel aggressive cancer subgroup, show frequent MYC amplification and expression. This finding suggests MYC may be a therapeutic target in these undifferentiated round cell sarcomas.

Area of Science:

  • Oncology
  • Molecular Pathology
  • Cancer Genomics

Background:

  • CIC-DUX sarcomas are a recently identified, aggressive subgroup of undifferentiated round cell sarcomas.
  • These tumors are characterized by specific molecular fusions involving the CIC gene and either DUX4 or DUX4L.
  • Morphological features include high-grade nuclear characteristics, clear cell foci, myxoid change, and necrosis.

Purpose of the Study:

  • To investigate the molecular alterations, particularly MYC pathway involvement, in a cohort of CIC-DUX sarcomas.
  • To assess the expression of ETS-family transcription factors in these tumors.
  • To evaluate potential therapeutic targets within CIC-DUX sarcomas.

Main Methods:

  • Analysis of a cohort of 10 CIC-DUX sarcoma cases, including 6 new cases and 2 with metastases.
  • Assays for trisomy 8, MYC (c-Myc) amplification and expression, and MYC downstream targets (p21, MTDH).
  • Immunohistochemical analysis for ERG and FLI1 expression.

Main Results:

  • Trisomy 8 was detected in 5/7 assessable cases.
  • MYC locus amplification was found in 6/7 cases, with universal MYC protein expression (10/10).
  • ERG (9/10) and FLI1 (8/8) positivity was prevalent, while p21 showed differential expression compared to Ewing sarcomas.

Conclusions:

  • MYC amplification and expression are highly prevalent in CIC-DUX sarcomas, indicating a potential therapeutic vulnerability.
  • The frequent expression of ERG and FLI1 necessitates caution in their use as sole diagnostic markers.
  • These findings highlight MYC as a promising therapeutic target for aggressive CIC-DUX sarcomas.

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