TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review

Abstract Perivascular epithelioid cell tumors (PEComas), rare mesenchymal neoplasms with heterogeneous behavior, are molecularly characterized by TSC2 inactivation driving mammalian target of rapamycin (mTOR) pathway activation. We present a typical case of a 63-year-old female with metastatic high-...

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Main Authors: Xiaopeng Suo, Ruihan Dong, Lingling Zhang, Xiaoying Zhang, Xiangji Li, Mengmeng Xiao
Format: Article
Language:English
Published: Springer 2025-07-01
Series:Discover Oncology
Subjects:
Online Access:https://doi.org/10.1007/s12672-025-03270-z
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author Xiaopeng Suo
Ruihan Dong
Lingling Zhang
Xiaoying Zhang
Xiangji Li
Mengmeng Xiao
author_facet Xiaopeng Suo
Ruihan Dong
Lingling Zhang
Xiaoying Zhang
Xiangji Li
Mengmeng Xiao
author_sort Xiaopeng Suo
collection DOAJ
description Abstract Perivascular epithelioid cell tumors (PEComas), rare mesenchymal neoplasms with heterogeneous behavior, are molecularly characterized by TSC2 inactivation driving mammalian target of rapamycin (mTOR) pathway activation. We present a typical case of a 63-year-old female with metastatic high-grade PEComa featuring a TSC2 mutation (68.57% VAF) and elevated tumor mutational burden (19.7 mut/Mb), manifesting as peritoneal carcinomatosis and pulmonary metastases. Everolimus therapy following multidisciplinary assessment induced a radiologically confirmed partial response within 4.5 months with sustained clinical benefit. This outcome validates mTOR inhibition in TSC2-mutated PEComas and underscores the imperative of molecular profiling in mesenchymal tumor management. The significant mutational burden suggests potential immunotherapy responsiveness, informing future combination strategies. These findings emphasize molecularly guided precision approaches in rare malignancies and warrant systematic exploration of therapeutic sequencing and resistance mechanisms in mTOR-driven tumors.
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institution Kabale University
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language English
publishDate 2025-07-01
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series Discover Oncology
spelling doaj-art-9ffa9061b7f44e9d8f4d01d96a33b2d92025-08-20T03:46:09ZengSpringerDiscover Oncology2730-60112025-07-0116111110.1007/s12672-025-03270-zTSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature reviewXiaopeng Suo0Ruihan Dong1Lingling Zhang2Xiaoying Zhang3Xiangji Li4Mengmeng Xiao5Department of Retroperitoneal Tumor Surgery, Peking University People’s HospitalDepartment of Nursing, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and TechnologyDaytime Comprehensive Care Unit, Peking University People’s HospitalDepartment of Pathology, Peking University International HospitalDepartment of Gastroenterology, Beijing Friendship Hospital, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Capital Medical UniversityDepartment of Retroperitoneal Tumor Surgery, Peking University People’s HospitalAbstract Perivascular epithelioid cell tumors (PEComas), rare mesenchymal neoplasms with heterogeneous behavior, are molecularly characterized by TSC2 inactivation driving mammalian target of rapamycin (mTOR) pathway activation. We present a typical case of a 63-year-old female with metastatic high-grade PEComa featuring a TSC2 mutation (68.57% VAF) and elevated tumor mutational burden (19.7 mut/Mb), manifesting as peritoneal carcinomatosis and pulmonary metastases. Everolimus therapy following multidisciplinary assessment induced a radiologically confirmed partial response within 4.5 months with sustained clinical benefit. This outcome validates mTOR inhibition in TSC2-mutated PEComas and underscores the imperative of molecular profiling in mesenchymal tumor management. The significant mutational burden suggests potential immunotherapy responsiveness, informing future combination strategies. These findings emphasize molecularly guided precision approaches in rare malignancies and warrant systematic exploration of therapeutic sequencing and resistance mechanisms in mTOR-driven tumors.https://doi.org/10.1007/s12672-025-03270-zPEComamTOR inhibitorEverolimusTSC2 mutationCase report
spellingShingle Xiaopeng Suo
Ruihan Dong
Lingling Zhang
Xiaoying Zhang
Xiangji Li
Mengmeng Xiao
TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review
Discover Oncology
PEComa
mTOR inhibitor
Everolimus
TSC2 mutation
Case report
title TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review
title_full TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review
title_fullStr TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review
title_full_unstemmed TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review
title_short TSC2-mutated perivascular epithelioid cell tumor with partial response to mTOR inhibition: a case report and literature review
title_sort tsc2 mutated perivascular epithelioid cell tumor with partial response to mtor inhibition a case report and literature review
topic PEComa
mTOR inhibitor
Everolimus
TSC2 mutation
Case report
url https://doi.org/10.1007/s12672-025-03270-z
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