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Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres

Last updated March 24, 2017


What are other Names for this Test? (Equivalent Terms)

  • Gene Mutation Analysis for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres
  • Test for Molecular Diagnosis of Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres

What is Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres? (Background Information)

  • Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres is a genetic test that is helpful in aiding a diagnosis of the tumor. The lab test results may also be subsequently useful in taking appropriate treatment decisions
  • Clear cell myomelanocytic tumor (CCMT) of falciform ligament/ligamentum teres is an extremely rare type of PEComa. As the name suggests, these tumors arise from the falciform ligament and ligament teres present in the right side of the liver
  • PEComa is a group of soft tissue tumors that show perivascular epithelioid-cell (PEC) differentiation. PEComa tumors may be benign, malignant, or of uncertain malignant potential
  • Clear cell myomelanocytic tumors of falciform ligament/ligamentum teres are mostly benign and are rarely known to be malignant (with metastatic tendency). These tumors can be associated with a syndrome (tuberous sclerosis) in some cases
  • Small-sized tumors may not present any significant signs and symptoms, while large tumors may compress the surrounding organs and structures causing pain and mass effect. Since the liver is involved, it can result in abdominal pain, weight loss, and easy bleeding (due to liver injury)

The cause of clear cell myomelanocytic tumor of falciform ligament/ligamentum teres may be due to genetic mutations. It is a type of PEComa tumor and the following abnormalities have been noted for PEComas:

  • One specific case of CCMT of liver showed translocation t(p3;10)
  • Currently, studies indicate defects in the following genes: TSC2 and TFE3
  • Additionally, the following chromosomal aberration is noted: Mutations in chromosome 16 due to loss of 16p (short arm)

The above genetic abnormalities can be detected using molecular studies, which may play a significant role in identifying the tumor type, and in some cases, helping the healthcare provider take appropriate treatment decisions.

The molecular testing, in general, can be performed using a variety of methods. Some of these methods include:

  • In situ hybridization technique, such as fluorescence in situ hybridization (FISH)
  • Immunohistochemistry (IHC)
  • Next-generation sequencing (NGS)
  • Polymerase chain reaction (PCR)
  • Comparative genomic hybridization (CGH)
  • Karyotyping including spectral karyotyping
  • mRNA analysis
  • Tissue microarrays (TMAs)
  • Southern blot test
  • Northern blot test
  • Western blot test
  • Eastern blot test

The methodology used for clear cell myomelanocytic tumor of falciform ligament/ligamentum teres may vary from one laboratory to another. 

Note: Molecular testing has limitations due to the molecular method and genetic mutational abnormalities being tested. This can affect the results on a case-by-case basis. Consultation with your healthcare provider will help in determining the right test and right molecular method, based on individual circumstances.

What are the Clinical Indications for performing the Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres Test?

Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres is undertaken in the following situations: 

  • To assist (and in some cases, confirm) the initial diagnosis of clear cell myomelanocytic tumor of falciform ligament/ligamentum teres
  • To distinguish other tumors/conditions that have similar histological features, when examined by a pathologist under the microscope
  • To help in determining treatment options
  • To confirm recurrence of the tumor: Tumor recurrence can either be at the original tumor site, or at a distant location (away from the initial site)

How is the Specimen Collected for Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres?

Following is the specimen collection process for Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres:

The specimen sample requirements may vary from lab to lab. Hence, it is important to contact the testing lab for exact specimen requirements, before initiating the testing process.

  • Sample on which the test is performed may include:
    • Fresh tumor tissue during biopsy
    • Formalin-fixed paraffin-embedded solid tumor tissue (FFPE tumor tissue), often referred to as paraffin block of the tumor
    • Unstained tissue slides
  • Process of obtaining the sample: As outlined by the laboratory testing facility
  • Preparation required: As outlined by the laboratory testing facility

Note:

  • In some cases, a different source of specimen (such as peripheral blood, bone marrow biopsy specimen, or other body fluids) may be acceptable to the laboratory performing the test
  • Occasionally, additional samples may be required to either repeat the test or to perform follow-up testing
  • Depending on the location of testing, it may take up to 2 weeks’ turnaround time, to obtain the test results
  • Many hospitals preserve the paraffin blocks for at least 7 years. In general, older paraffin blocks (over 5 years) may affect the detection of specific mutations, due to degradation of the tumor specimen over time

Cost of Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres:

  • The cost of the test procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities
  • In many cases, an estimate may be provided before the test is conducted. The final amount may depend upon the findings during the test procedure and post-operative care that is necessary (if any)

What is the Significance of the Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres Result?

The significance of Molecular Testing for Clear Cell Myomelanocytic Tumor of Falciform Ligament/Ligamentum Teres is explained:

  • Presence of a positive test result helps aid, and in some cases, confirm the diagnosis of clear cell myomelanocytic tumor of falciform ligament/ligamentum teres
  • The result can help exclude other tumors with similar histological features
  • It can help determine the prognosis of the patient
  • In some cases, the test results may help in taking treatment decisions

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.

Additional and Relevant Useful Information:

  • Many laboratories may not have the capability to perform this test. Only highly-specialized labs with advanced facilities and testing procedures may perform this test
  • Additional mutations are still being discovered in many of these tumors. This may further contribute towards tumor diagnosis and treatment. Please consult with your healthcare provider for any information updates

Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

What are some Useful Resources for Additional Information?

Please visit our Laboratory Procedures Center for more physician-approved health information:

http://www.dovemed.com/common-procedures/procedures-laboratory/

References and Information Sources used for the Article:

https://ghr.nlm.nih.gov/primer/testing/genetictesting (accessed on 03/20/2017)

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5806a1.htm (accessed on 03/20/2017)

http://www.nature.com/gim/journal/v10/n5/full/gim200852a.html (accessed on 03/20/2017)

http://pediatrics.aappublications.org/content/106/6/1494 (accessed on 03/20/2017)

http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2014;volume=57;issue=3;spage=453;epage=455;aulast=Tan (accessed on 03/20/17)

https://www.hindawi.com/journals/crim/2013/904126/ (accessed on 03/20/17)

https://www.ncbi.nlm.nih.gov/pubmed/25118744 (accessed on 03/20/17)

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Druker, B. J. Perspectives on the development of a molecularly targeted agent. Cancer Cell 1, 31–36 (2002)

Parra, I., & Windle, B. High resolution visual mapping of stretched DNA by fluorescent hybridization. Nature Genetics 5, 17–21 (1993) doi:10.1038/ng0993-17

Pinkel, D., et al. High resolution analysis of DNA copy number variation using comparative genomic hybridization to microarrays. Nature Genetics 20, 207–211 (1998) doi:10.1038/2524

Speicher, M. R., et al. Karyotyping human chromosomes by combinatorial multi-fluor FISH. Nature Genetics 12, 368–375 (1996) doi:10.1038/ng0496-368

Folpe, A. L., Goodman, Z. D., Ishak, K. G., Paulino, A. F., Taboada, E. M., Meehan, S. A., & Weiss, S. W. (2000). Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults. The American journal of surgical pathology, 24(9), 1239-1246.

Tan, Y., Zhang, H., & Wang, X. C. (2014). Clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres. Indian Journal of Pathology and Microbiology, 57(3), 453.

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Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 24, 2017
Last updated: March 24, 2017