NTRK-rearranged mesenchymal tumours: diagnostic challenges, morphological patterns and proposed testing algorithm

Daniel D. Wong*, Ana Cristina Vargas, Fiona Bonar, Fiona Maclean, Joseph Kattampallil, Colin Stewart, Ban Sulaiman, Leonardo Santos, Anthony J. Gill

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


Oncogenic fusions involving neurotrophic receptor tyrosine kinase (NTRK) genes are being increasingly identified in a range of mesenchymal tumours unrelated to infantile fibrosarcoma or cellular congenital mesoblastic nephroma, where the canonical ETV6-NTRK3 fusion was first described more than two decades ago. Recognition of these NTRK-rearranged tumours poses a diagnostic challenge to surgical pathologists due to their non-specific clinical and pathological features. However, their recognition is of heightened importance, particularly in locally advanced and metastatic sarcomas, due to the recent availability of selective and highly effective targeted therapy. Herein, we present an Australian multi-institutional series of six of these rare NTRK-rearranged mesenchymal neoplasms to share the local experience and diagnostic challenges as well as to highlight key morphological patterns and immunoprofiles that provide the most helpful clues in routine practice. We also propose a diagnostic algorithm for the detection of these fusions, drawing attention to the limitations of ancillary studies including immunohistochemistry against tropomyosin receptor kinase (TRK) protein, fluorescence in situ hybridisation (FISH) and next generation sequencing.

Original languageEnglish
Pages (from-to)401-409
Number of pages9
Issue number4
Publication statusPublished - 1 Jun 2020


  • entrectinib
  • larotrectinib
  • mesenchymal tumours
  • NTRK
  • pan-TRK
  • sarcoma
  • soft tissue tumours
  • TRK


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