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EGFR Exon 20 Insertion/Duplication Mutations Characterize Fibrous Hamartoma of Infancy

Park, Jason Y. MD, PhD; Cohen, Cynthia MD; Lopez, Dania BS; Ramos, Erica BS; Wagenfuehr, Jennifer BS; Rakheja, Dinesh MD

The American Journal of Surgical Pathology: December 2016 - Volume 40 - Issue 12 - p 1713–1718
doi: 10.1097/PAS.0000000000000729
Original Articles

Fibrous hamartoma of infancy (FHI) is a benign mesenchymal tumor histologically characterized by a mixture of intersecting fascicles of fibroblasts/myofibroblasts in collagenous stroma, nests of primitive oval or stellate cells in basophilic mucoid stroma, and mature adipose tissue. We hypothesized that FHI, because of histologic overlap with mesenchymal overgrowth tumors seen in CLOVES (Congenital Lipomatous Overgrowth with Vascular, Epidermal, Skeletal anomalies) and Proteus syndromes, may harbor mutations in signaling pathways associated with cellular proliferation. Formalin-fixed paraffin-embedded material from a discovery set of 4 cases of FHI was investigated by targeted next-generation sequencing of a panel of cancer-associated genes. The results were confirmed by targeted Sanger sequencing of EGFR exon 20. A validation set of 8 cases of FHI and 10 cases of other pediatric fatty tumors were investigated by targeted Sanger sequencing of EGFR exon 20. All 12 cases of FHI, and none of the 10 control tumors, showed EGFR exon 20 insertion/duplication mutations. This is the first report of molecular aberrations in FHI. The consistent occurrence of EGFR exon 20 insertion/duplication mutations in 100% of cases of FHI studied suggests that they must play a principal role in the pathogenesis of FHI, likely by conferring a potential for growth and local infiltration. Although surgical treatment will remain the mainstay of FHI treatment, tyrosine kinase inhibitors may have an adjunctive role in cases that are difficult to resect.

Departments of *Pathology

Pediatrics, University of Texas Southwestern Medical Center

Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center

Department of Pathology and Laboratory Medicine, Children’s Health, Children’s Medical Center, Dallas, TX

§Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA

Conflicts of Interest and Source of Funding: Supported in part by a grant from the Children’s Medical Center Foundation, Dallas, TX (to D.R.). D.R. is supported by John Lawrence and Patsy Louise Goforth Distinguished Professorship in Pathology. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Dinesh Rakheja, MD, Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9073 (e-mail:

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