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Updated: Apr 27, 2026

Mapping the Structure-Function Relationships of Disordered Oncogenic Transcription Factors Using Transcriptomic Analysis
Published on: June 27, 2020
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.
Abstract:
Recent molecular advances have identified a novel, clinically aggressive subgroup of undifferentiated round cell sarcomas defined molecularly by oncogenic fusion of the gene, CIC, and either DUX4 or its paralog, DUX4L, herein termed CIC-DUX sarcomas. Morphologically, CIC-DUX sarcomas are round cell sarcomas with high-grade nuclear features, including vesicular chromatin and nucleoli, patchy clear cell foci, myxoid change, and necrosis. Here, we studied a cohort of 10 cases, including 6 newly identified cases, 2 with paired metastases. Given our prior observation of trisomy 8 in these tumors, we assayed for amplification and expression of MYC (c-Myc) and representative downstream targets. Trisomy 8 was detected in 5/7 testable cases, with further amplification of MYC locus in 6/7 testable cases and immunohistochemical expression of MYC in 10/10. The canonical MYC transcriptional target, p21, but not MTDH, was differentially expressed compared with Ewing sarcomas. Given prior observation of induction of ETS-family transcription factors by the fusion oncoprotein, we assayed and identified highly prevalent positivity for ERG (9/10) and FLI1 (8/8). These findings are cautionary regarding use of these immunostains in prospective case workup, whereas the prevalent MYC amplification may represent a therapeutically targetable oncogenic pathway in CIC-DUX sarcomas.
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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