Chondroid lipoma is a rare benign tumor of adipose tissue origin that may mimic myxoid chondrosarcoma and liposarcoma. Recognition of an identical 11;16 translocation in six chondroid lipoma cases [three current cases and three previously reported (
Thomson et al., 1999;
Gisselsson et al., 1999a;
Ballaux et al., 2004)] prompted our efforts in mapping the breakpoints and defining the underlying involving genes. Recurrent chromosomal translocations leading to the formation of chimeric genes have been identified in a number of benign and malignant bone and soft tissue tumors and are believed to be involved in the early development of these tumors (
Unni et al., 2005;
Ladanyi et al., 2008;
Mandahl and Mertens, 2009). The fusion oncogenes found in sarcomas are dominated by the creation of aberrant transcription factors. Rearrangements involving the high mobility group A family of genes (
HMGA2 and
HMGA1) are common in benign mesenchymal tumors including lipoma and pulmonary chondroid hamartoma among others (
Fletcher et al., 1995;
Schoenmakers et al., 1995;
Ladanyi et al., 2008;
Mandahl and Mertens, 2009). The HMGA proteins have an intrinsic flexibility that permit their important role in regulating transcription and chromatin architectural control (
Reeves and Beckerbauer, 2001). In ordinary lipoma,
HMGA2 is most frequently fused to
LPP. Interestingly,
Kubo et al. (2006) demonstrated that in addition to its role in adipogenesis, the HMGA2-LPP fusion protein may promote chondrogenesis.
In the current study, a
C11orf95-MKL2 fusion was identified in three chondroid lipomas carrying a t(11;16)(q13;p13).
C11orf95 encodes a 678 amino acid hypothetical protein of unknown function that exhibits expression in a wide variety of human tissues (
Ota et al., 2004). This protein contains four polyglutamic rich and one proline rich region. The
MKL2 gene codes for a 1049 amino acid myocardin-like protein and is a member of the myocardin/megakaryoblastic leukemia gene family (
Selvaraj and Prywes, 2003). MKL2, an SAP (SAF-A, acinus, PIAS) DNA-binding domain containing protein, has been functionally implicated in chromatin remodeling in addition to serving as a transcriptional co-activator of SRF (serum response factor) (
Selvaraj and Prywes, 2003).
In all three chondroid lipoma cases, exons 1–5 of
C11orf95 were fused in-frame to the last five exons of
MKL2. This chimeric transcript encompasses all putative functional motifs encoded by each gene. The C-terminal portion of the C11orf95-MKL2 chimeric protein contains a SAP DNA-binding domain, a coiled-coiled (CC) domain and a proline-rich region known to be present in transcription factors and oncoproteins. Interestingly, a rearrangement involving another
MKL gene family member (
MKL1) has been identified in t(1;22)(p13;q13) acute megakaryoblastic leukemia (
Ma et al., 2001;
Cen et al., 2003) and t(1;22)(p13;q13) acute myeloid leukemia, subtype M1 (
Hsiao et al., 2005). This translocation results in a fusion of
RBM15 and
MKL1 that also encompasses all putative functional motifs encoded by each gene. Additional studies must be conducted to determine the functionality of the
C11orf95-MKL2 fusion oncogene in chondroid lipoma.
Recurrent involvement of the 11q13 region has also been found in another benign adipose tissue tumor, hibernoma, as well as in a common benign renal tumor, oncocytoma (
Mertens et al., 1994;
Sandberg, 2004;
Sukov et al., 2009). The 11q13 rearrangement in renal oncocytoma has been shown to involve
CCND1, however, the underlying 11q13 gene involved in hibernoma has not yet been identified (
Sukov et al., 2009). Unlike in chondroid lipoma, 11q13 has not been shown to recombine with 16p12-13 in hibernoma. Gisselsson et al. reported five cases of hibernoma with complex rearrangements of chromosome 11, leading to loss of chromosome material in 11q13 (
Gisselsson et al., 1999b). The most commonly deleted segment included the
MEN1 gene. However, in the chondroid lipoma case described by Gisselsson et al., no deletions were found. With the intention of determining if hibernoma shares the same chromosome 11 breakpoint with chondroid lipoma, we performed FISH analysis using the two-color chromosome 11 breakpoint probe set RP11-697H9 and RP11-466C23 on hibernoma metaphase cells with 11q13 rearrangement. There was no disruption of these probe signals in the abnormal metaphase cells indicating that a gene other than
C11orf95 is likely involved (data not shown).
Chondroid lipoma is a rare entity and may be mistaken for several other benign and malignant soft tissue tumors such as extraskeletal chondroma, liposarcoma, extraskeletal myxoid chondrosarcoma, and myoepithelioma/mixed tumor (
Kindblom et al., 2002;
Weiss and Goldblum, 2008). Unlike chondroid lipoma, myxoid liposarcoma usually exhibits a uniform population of stellate or spindled cells and an arborizing capillary proliferation. Extraskeletal myxoid chondrosarcoma is devoid of a prominent vascular proliferation, but contains uniform oval or spindled cells without cytoplasmic vacuoles, lipoblasts, or mature adipocytes. Both of these sarcomas harbor unique chromosomal abnormalities that can be identified with conventional cytogenetic, molecular cytogenetic, or molecular (e.g. RT-PCR) approaches for diagnostic purposes (
Bridge, 2008). Extraskeletal chondroma frequently arises more peripherally than chondroid lipoma and contains abundant hyaline cartilage, a finding not typical of chondroid lipoma. Cytogenetic studies of extraskeletal chondroma or soft part chondroma have not revealed a tumor-specific anomaly although involvement of chromosomal region 12q12~15 appears to be recurrent in a subset of these tumors (
Buddingh et al., 2003). Lastly, myoepitheliomas may show a broad spectrum of histologic appearances, but often are composed of spindled and epithelioid cells, some of which may contain vacuoles deposited in a variably chondromyxoid or hyalinized stroma. However in contrast to chondroid lipoma, myoepithelioma lacks adipocytes and lipoblasts and features significantly stronger immunoreactivity to antibodies for epithelial differentiation. Cytogenetic or array comparative genomic hybridization studies of soft tissue myoepitheliomas are rare, however,
EWSR1 rearrangements or deletion within 19p13 have been identified as recurrent anomalies in subsets of these neoplasms (
van den Berg et al., 2004;
Balogh et al., 2008;
Brandal et al., 2008;
Hallor et al., 2008;
Brandal et al., 2009).
In conclusion, chondroid lipoma is characterized by chromosomal translocation t(11;16)(q13;p13) resulting in the fusion of the C11orf95 and MKL2 genes. Novel FISH and RT-PCR assays developed in this study can serve as valuable diagnostic adjuncts for this rare disease entity, particularly when evaluating small samples or when fresh tissue is not available.