{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T19:15:59Z","timestamp":1788030959849,"version":"build-2784847793"},"reference-count":21,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clear cell sarcoma (CCS) is a rare soft tissue sarcoma that primarily affects individuals ages 20-40. It typically presents as a slow-growing, often painless, mass in the extremities. Wide resection is the mainstay of treatment, though local recurrence and metastatic disease are common despite surgery. This case series highlights our experience treating CCS within the military population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This is a retrospective case series of 3 patients treated at our institution between 2016 and 2026 with biopsy-confirmed CCS. Median survival, local recurrence, and incidence of metastatic disease are reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three male patients aged 17, 21, and 24 years were diagnosed with genetically confirmed CCS of the thigh. One patient was local to our institution\u2019s area, and the remaining 2 were stationed across the country and therefore underwent initial workup at other hospitals. Tumor size ranged from 5.7 to 14.6 cm, and all lesions demonstrated an EWSR1-ATF1 translocation. Two patients presented with regional nodal metastases at diagnosis, while 1 developed nodal metastasis 6 months after treatment. All patients underwent multimodal therapy consisting of radiation therapy and surgical resection, with 2 receiving prophylactic carbon fiber intramedullary nail fixation. Postoperative complications included wound dehiscence in 2 patients and vascular graft occlusion in 1 patient. Despite additional systemic therapy, all patients developed progressive metastatic disease, including lymph node, pulmonary, and spinal metastases. Overall survival following diagnosis was 12, 12, and 21 months, respectively, with all patients ultimately succumbing to disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CCS is an aggressive tumor with a high rate of local recurrence and metastatic disease. Overall survival is poor, and prompt treatment and early referral to an orthopedic oncologist are paramount to improve patient outcomes. Military providers should be aware of this rare entity, as it primarily affects military-age men and women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag403","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:42:12Z","timestamp":1786448532000},"source":"Crossref","is-referenced-by-count":0,"title":["Clear Cell Sarcoma: A Military Case Series"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2987-5663","authenticated-orcid":false,"given":"James D","family":"Baker","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4289-8907","authenticated-orcid":false,"given":"Mason","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1195-8780","authenticated-orcid":false,"given":"Josiah","family":"Snowden","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Barney","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9579-9924","authenticated-orcid":false,"given":"James","family":"Albright","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1081-6711","authenticated-orcid":false,"given":"Gavin","family":"Mills","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2590-6332","authenticated-orcid":false,"given":"Dustin O","family":"Lybeck","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"2026082914351021000_usag403-B1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/j.1365-2559.2005.02285.x","article-title":"The role of genetic testing in soft tissue sarcoma","volume":"48","author":"Antonescu","year":"2006","journal-title":"Histopathology"},{"key":"2026082914351021000_usag403-B2","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1002\/1097-0142(196509)18:9&lt;1163::aid-cncr2820180916&gt;3.0.co","article-title":"Clear-cell sarcoma of tendons and aponeuroses. An analysis of 21 cases","volume":"18","author":"Enzinger","year":"1965","journal-title":"Cancer"},{"key":"2026082914351021000_usag403-B3","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1053\/j.seminoncol.2009.06.007","article-title":"Sarcomas with spindle cell morphology","volume":"36","author":"Collini","year":"2009","journal-title":"Semin Oncol"},{"key":"2026082914351021000_usag403-B4","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1097\/PAT.0000000000000050","article-title":"WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition","volume":"46","author":"Jo","year":"2014","journal-title":"Pathology"},{"key":"2026082914351021000_usag403-B5","first-page":"1482","article-title":"Clear-cell sarcoma soft tissues: analysis 58 cases","volume":"50","author":"Shmookler","year":"1982","journal-title":"Cancer"},{"key":"2026082914351021000_usag403-B6","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1302\/0301-620X.105B11.BJJ-2022-0743.R3","article-title":"Factors associated with survival in patients with clear cell sarcoma: a nationwide database study","volume":"105-B","author":"Fujiwara","year":"2023","journal-title":"Bone Joint J"},{"key":"2026082914351021000_usag403-B7","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1111\/his.14265","article-title":"Updates from the 2020 world health organization classification of soft tissue and bone tumours","volume":"78","author":"Anderson","year":"2021","journal-title":"Histopathology"},{"key":"2026082914351021000_usag403-B8","first-page":"416","article-title":"Molecular classification of soft tissue sarcomas and its clinical applications","volume":"3","author":"Jain","year":"2010","journal-title":"Int J Clin Exp Pathol"},{"key":"2026082914351021000_usag403-B9","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.3390\/jcm14041233","article-title":"Clear cell sarcoma (CCS) of the soft tissue: an update narrative review with emphasis on the utility of PRAME in differential diagnosis","volume":"14","author":"Cazzato","year":"2025","journal-title":"J Clin Med"},{"key":"2026082914351021000_usag403-B10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/(SICI)1096-9896(199809)186:1&lt;3::AID-PATH153&gt;3.0.CO","article-title":"Clear cell sarcoma of tendons and aponeuroses (malignant melanoma of soft parts) and cutaneous melanoma: exploring the histogenetic relationship between these two clinicopathological entities","volume":"186","author":"Graadt van Roggen","year":"1998","journal-title":"J Pathol"},{"key":"2026082914351021000_usag403-B11","doi-asserted-by":"publisher","first-page":"e85606","DOI":"10.7759\/cureus.85606","article-title":"Clear cell sarcoma incidence and survival: a surveillance, epidemiology, and end results (SEER) database analysis","volume":"17","author":"Wang","year":"2025","journal-title":"Cureus"},{"key":"2026082914351021000_usag403-B12","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1007\/s00432-018-2693-6","article-title":"The epidemiology and survivorship of clear cell sarcoma: a national cancer database (NCDB) review","volume":"144","author":"Gonzaga","year":"2018","journal-title":"J Cancer Res Clin Oncol"},{"key":"2026082914351021000_usag403-B13","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.ejso.2014.01.016","article-title":"Clear cell sarcoma of soft tissue: a retrospective review and analysis of 31 cases treated at Istituto Ortopedico Rizzoli","volume":"40","author":"Bianchi","year":"2014","journal-title":"Eur J Surg Oncol"},{"key":"2026082914351021000_usag403-B14","doi-asserted-by":"publisher","first-page":"6950","DOI":"10.12659\/MSM.916705","article-title":"Prognostic factors for survival in patients with clear cell sarcoma: an analysis of the surveillance, epidemiology, and end results (SEER) database","volume":"25","author":"Li","year":"2019","journal-title":"Med Sci Monit"},{"key":"2026082914351021000_usag403-B15","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1002\/cncr.22380","article-title":"Clear cell sarcoma of tendons and aponeuroses: a study of 75 patients: a study of 75 patients","volume":"109","author":"Kawai","year":"2007","journal-title":"Cancer"},{"key":"2026082914351021000_usag403-B16","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1302\/0301-620X.108B2.BJJ-2025-0526.R1","article-title":"Clear cell sarcoma: a retrospective review from a tertiary orthopaedic sarcoma unit: a retrospective review from a tertiary orthopaedic sarcoma unit","volume":"108-B","author":"Green","year":"2026","journal-title":"Bone Joint J"},{"key":"2026082914351021000_usag403-B17","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1080\/14737140.2016.1197122","article-title":"Biology and management of clear cell sarcoma: state of the art and future perspectives","volume":"16","author":"Cornillie","year":"2016","journal-title":"Expert Rev Anticancer Ther"},{"key":"2026082914351021000_usag403-B18","doi-asserted-by":"publisher","first-page":"100522","DOI":"10.1016\/j.esmoop.2022.100522","article-title":"Systemic treatment of advanced clear cell sarcoma: results from a retrospective international series from the world sarcoma network","volume":"7","author":"Smrke","year":"2022","journal-title":"ESMO Open"},{"key":"2026082914351021000_usag403-B19","doi-asserted-by":"publisher","first-page":"3303","DOI":"10.1111\/cas.14542","article-title":"Phase II trial of pazopanib in patients with metastatic or unresectable chemoresistant sarcomas: a Japanese musculoskeletal oncology group study","volume":"111","author":"Urakawa","year":"2020","journal-title":"Cancer Sci"},{"key":"2026082914351021000_usag403-B20","doi-asserted-by":"publisher","first-page":"8999","DOI":"10.2147\/CMAR.S337253","article-title":"Clinical experience with apatinib and camrelizumab in advance clear cell sarcoma: a retrospective study","volume":"13","author":"Wang","year":"2021","journal-title":"Cancer Manag Res"},{"key":"2026082914351021000_usag403-B21","doi-asserted-by":"publisher","first-page":"3000","DOI":"10.1093\/annonc\/mdx527","article-title":"Activity and safety of crizotinib in patients with advanced clear-cell sarcoma with MET alterations: European organization for research and treatment of cancer phase II trial 90101 CREATE","volume":"28","author":"Sch\u00f6ffski","year":"2017","journal-title":"Ann Oncol"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag403\/70870128\/usag403.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag403\/70870128\/usag403.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T18:35:16Z","timestamp":1788028516000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag403\/8776072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":21,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag403","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]},"article-number":"usag403"}}