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Master Thesis

Intégrer la vascularisation macroscopique des sarcomes des parties molles en IRM conventionnelle pour identifier des sous-types rares de sarcomes et améliorer la prédiction du pronostic des patients

Abstract : Alveolar soft part sarcomas (ASPS) are characterized by an important angiogenesis, translating into MRI through T1 hyperintensity and flow voids (FV). However theses signs are also observed in other histological types, which is at a risk of misdiagnosis with benign vascular tumors. Our first study aimed to describe MRI signs that could help discriminating ASPS from other soft tissue masses in a retrospective multicentric case-control study of 25 ASPS and 292 control tumors. Eight signs were associated to ASPS: deep location, T1 hyperintensity, central necrosis, absence of fibrosis, infiltrative margins, intra/peritumoral FV, ≥5 FV, and absence of tail sign. All ASPS displayed at least 5 of these 8 signs versus 14% of controls. This study stressed the relative frequency of FV, as simple indicator of neo-angiogenesis on conventional MRI, but whose practical significance was yet to be investigated. The aim of our second study was to evaluate the diagnostic and prognostic values of MRI signs arising from the analysis of FVs in a retrospective cohort of 157 patients from Bergonié Institute (including ASPS from this sarcoma reference center). In total 18,5% showed FVs. FVs were present in a various range of histological types. There was no association between FV characteristics and the histological grade but tumors presenting ≥ 5 FV were all at least of intermediate grade. FV distribution was associated with poorer metastase-free and overall survivals (p=0.014 and p=0.039), especially the presence of peritumoral FVs (p=0.003 and p=0,006). The link between FV and survival could be explained by an increased risk of hematogenous spread. Moreover, tumors with the more numerous FV count are of histological subtympes known to overexpress pro-angiogenic factors, and we can thus hypothesize an interest of FV as biomarker of anti-angiogenic treatment sensitivity.
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https://dumas.ccsd.cnrs.fr/dumas-03012405
Contributor : Médecine Ub <>
Submitted on : Wednesday, November 18, 2020 - 3:12:12 PM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM
Long-term archiving on: : Friday, February 19, 2021 - 8:00:42 PM

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Pauline Ledoux. Intégrer la vascularisation macroscopique des sarcomes des parties molles en IRM conventionnelle pour identifier des sous-types rares de sarcomes et améliorer la prédiction du pronostic des patients. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03012405⟩

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