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Wu Y, Ji H, Zhang S, Zhang Y, Chu W, Mei Y, Niu W, Zhang B. Primary primitive neuroectodermal tumor of urinary bladder: a case report and literature review. Transl Cancer Res 2022; 10:4997-5004. [PMID: 35116350 PMCID: PMC8797345 DOI: 10.21037/tcr-21-864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022]
Abstract
Primary primitive neuroectodermal tumor (PNET) of the bladder is an extremely rare and highly aggressive neoplasm. We report a case of PNET of the urinary bladder associated with increased serum neuron-specific enolase (NSE) in the presence of relapse and metastasis. A 66-year-old male presented to our department due to painless gross hematuria. Computed tomographic urography (CTU) showed an intraluminal tumor in the anterior bladder wall. Biopsy revealed a malignant small round blue cell tumor. The patient denied radical cystectomy, and partial cystectomy was given together with resection of adjacent peritoneum. The patient was diagnosed with primary bladder PNET after pathological inspection with negative surgical margins. Additionally, he received 6 cycles of chemotherapy using etoposide and cisplatin (EP) regime, and showed recurrence and metastasis afterwards. Disease progression was seen after transurethral resection (TUR) of bladder tumor and radiotherapy. Pelvic and retroperitoneal metastasis triggered bilateral hydronephrosis, and then palliative treatment was given with bilateral percutaneous nephrostomy. Finally, he died 12 months after diagnosis. PNETs are highly aggressive tumors characterized by the expression of MIC2 and neural markers and the presence of EWS-FLI1 translocation. We recommend histologic, immunohistochemical, and cytogenetic analysis in all patients with small round blue cell bladder malignancy in order to rule out other small cell malignancies. Multimodal treatment, including surgery and adjuvant chemotherapy must be initiated. Patients aged ≤30 years underwent complete resection of tumor and standard chemotherapy showed a better prognosis, while those with metastasis, incomplete resection and inadequate response to chemotherapy showed poor prognosis. Moreover, an elevated NSE may indicate a poor prognosis.
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Affiliation(s)
- Yuhai Wu
- Department of Urology, Binzhou Medical University Hospital, Binzhou, China
| | - Hong Ji
- Department of Pathology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Shudong Zhang
- Department of Psychology, Binzhou Medical University Hospital, Binzhou, China
| | - Yangyang Zhang
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Chu
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou, China
| | - Wenjie Niu
- Department of Urology, Binzhou Medical University Hospital, Binzhou, China
| | - Bing Zhang
- Department of Urology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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2
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Marais YA, Saini AK, Ferreira N, Reddy K, Zühlke A, Rossouw N, Zaharie SD, Schubert PT. Adamantinoma-like Variant of Ewing Sarcoma in the Metatarsal Bone After Chemotherapy: Report of a Case Successfully Treated with Pedicled Osteocutaneous Fibular Transfer. Int J Surg Pathol 2021; 29:798-803. [PMID: 33703949 DOI: 10.1177/10668969211001449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adamantinoma-like Ewing sarcoma is a rare variant of Ewing sarcoma with histologic and immunohistochemical evidence of squamous differentiation. This variant most commonly occurs in the head and neck region with a few cases reported in the long bones of the limbs. It may be associated with poorer clinical outcome and could pose a diagnostic challenge, particularly if it occurs in older patients or as a metastatic lesion. We present a case of Ewing sarcoma in the metatarsal of an 11-year-old boy that manifested adamantinoma-like morphology after neoadjuvant chemotherapy. Chemotherapy has been reported to induce neuronal maturation and rhabdoid morphology in cases of Ewing sarcoma, but no reports of treatment-induced squamous differentiation with P40/P63 expression have been demonstrated. This is also the first documented case treated with a pedicled osteocutaneous fibular transfer in a metatarsal malignancy, which is usually treated by either ray or below-knee amputation.
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Affiliation(s)
- Yolandi A Marais
- National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa
| | - Aaron K Saini
- 26697Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa
| | - Nando Ferreira
- 26697Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa
| | - Kershinee Reddy
- Paediatric Oncology Unit, 26697Stellenbosch University, Cape Town, South Africa
| | - Alexander Zühlke
- Division of Plastic and Reconstructive Surgery, 26697Stellenbosch University, Cape Town, South Africa
| | - Nelmarie Rossouw
- Division of Radiodiagnosis, 26697Stellenbosch University, Cape Town, South Africa
| | - Stefan D Zaharie
- National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa
| | - Pawel T Schubert
- National Health Laboratory Service, 121470Stellenbosch University, Cape Town, South Africa
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3
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Lv M, Shen L, Li J, Xie Y, Wei L. Congenital cutaneous peripheral primitive neuroectodermal tumor/Ewing sarcoma: A rare case in a male neonate. Pediatr Blood Cancer 2019; 66:e27958. [PMID: 31429518 DOI: 10.1002/pbc.27958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/21/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Mengxing Lv
- Department of Pathology, Kunming Children's Hospital, Kunming, China
| | - Lan Shen
- Department of Emergency, First People's Hospital of Honghe State, Honghe, China
| | - Jiwei Li
- Department of Pathology, Kunming Children's Hospital, Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital, Kunming, China
| | - Lizheng Wei
- Department of Echocardiography, Kunming Children's Hospital, Kunming, China
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4
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Haas JA, Rice D, Morrison CS. Ewing Sarcoma Presenting as a Congenital Scalp Mass. Cleft Palate Craniofac J 2018; 56:538-542. [PMID: 29989837 DOI: 10.1177/1055665618787100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ewing sarcoma is a locally aggressive, highly malignant tumor most commonly seen in the skeletal system. The "Ewing family of tumors" also includes other tissue types that are not common, such as soft tissue origin classified as extraosseous Ewing sarcoma (EES) or primitive neuroendocrine origin. Age of onset most often occurs within the first 2 decades of life. Congenital presentation of EES is exceedingly rare. We report the first described case to our knowledge of congenital EES originating from the scalp.
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Affiliation(s)
- Jacqueline A Haas
- 1 Division of Plastic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Dahlia Rice
- 1 Division of Plastic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Clinton S Morrison
- 1 Division of Plastic Surgery, University of Rochester Medical Center, Rochester, NY, USA
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5
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Jin SG, Jiang XP, Zhong L. Congenital Ewing's Sarcoma/Peripheral Primitive Neuroectodermal Tumor: A Case Report and Review of the Literature. Pediatr Neonatol 2016; 57:436-439. [PMID: 24480101 DOI: 10.1016/j.pedneo.2013.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 10/09/2013] [Accepted: 11/02/2013] [Indexed: 11/18/2022] Open
Abstract
Ewing's sarcoma (EWS) and peripheral primitive neuroectodermal tumor (pPNET) are small round cell malignancies that develop in soft tissue and bone. They very rarely affect newborns. A diagnosis of EWS/pPNET depends mainly on immunohistochemistry and molecular/genetic assays. Since these tumors are highly aggressive, patient prognosis is typically very poor, and treatment remains a challenge. Here, we report a 13-day-old newborn diagnosed with congenital EWS/pPNET and describe its treatment.
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MESH Headings
- Bone Neoplasms/congenital
- Bone Neoplasms/pathology
- Bone Neoplasms/therapy
- Female
- Humans
- Immunohistochemistry
- Infant, Newborn
- Neuroectodermal Tumors, Primitive, Peripheral/congenital
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Sarcoma, Ewing/congenital
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/therapy
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Affiliation(s)
- Shu-Guang Jin
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Xiao-Ping Jiang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lin Zhong
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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6
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Goyal S, Biswas A, Gupta R, Mohanti BK. Congenital peripheral primitive neuroectodermal tumor: A case treated successfully with multimodality treatment. J Egypt Natl Canc Inst 2014; 26:219-24. [DOI: 10.1016/j.jnci.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/07/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022] Open
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7
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Ghattas TN, Lucas G. Peripheral Primitive Neuroectodermal Tumor of the Chest Wall in a Neonate: A Case Report. JBJS Case Connect 2013; 3:e36. [PMID: 29252230 DOI: 10.2106/jbjs.cc.k.00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Timothy N Ghattas
- Department of Surgery, Section of Orthopaedics, University of Kansas School of Medicine - Wichita, 929 North St. Francis, Room 4076, Wichita, KS 67214
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8
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Crocoli A, Bagolan P, Boldrini R, Natali GL, De Ioris MA, Morini F. Congenital Askin tumor with favorable outcome: case report and review of the literature. J Pediatr Surg 2012; 47:1440-4. [PMID: 22813811 DOI: 10.1016/j.jpedsurg.2012.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 02/17/2012] [Accepted: 02/22/2012] [Indexed: 11/19/2022]
Abstract
Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.
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Affiliation(s)
- Alessandro Crocoli
- General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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9
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43 year old male with a right pelvic mass. ACTA ACUST UNITED AC 2012; 8:225-6. [PMID: 22440360 DOI: 10.1016/j.reuma.2011.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/18/2011] [Accepted: 09/19/2011] [Indexed: 11/23/2022]
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10
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Busato WFS, Almeida GL, Ogata DC. Primary primitive neuroectodermal tumor of the bladder: histologic and clinical features of 9 cases. Clin Genitourin Cancer 2011; 9:63-7. [PMID: 21729681 DOI: 10.1016/j.clgc.2011.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/08/2011] [Accepted: 03/29/2011] [Indexed: 11/30/2022]
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11
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Ban SP, Park SH, Wang KC, Cho BK, Phi JH, Lee JY, Kim SK. Congenital paraspinal Ewing sarcoma family of tumors with an epidural extension. J Clin Neurosci 2011; 17:1599-601. [PMID: 20817468 DOI: 10.1016/j.jocn.2010.03.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 03/22/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
Congenital Ewing sarcoma family of tumors (ESFT) is a rare disease, and only 12 patients have been reported. Among those patients, only two had paraspinal tumors with an epidural extension. A 3-week-old infant boy presented with a huge dorsal mass. Whole-spine MRI scans showed a paraspinal mass with an epidural extension from the T11 to L2 levels, causing severe spinal cord compression. An initial operation was performed to confirm the pathological diagnosis. Twenty days after the first operation, the patient showed left lower-extremity weakness. A second operation was performed with a laminectomy from the T11 to L2 levels, and the epidural mass was radically resected. Pathologically, the tumor was confirmed as an ESFT. The patient received adjuvant chemotherapy. His neurological deficit recovered after the second surgery, and there was no tumor recurrence during 17 months of follow-up.
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Affiliation(s)
- Seung Pil Ban
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul 110-744, Republic of Korea
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12
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Abstract
Two hundred eight neonates with malignant tumors and cutaneous metastases were reviewed. Malignancies most often associated with cutaneous metastases, in order of rank, were leukemia, multisystem Langerhans cell histiocytosis, neuroblastoma, rhabdoid tumor, rhabdomyosarcoma, primitive neuroectodermal tumor, choriocarcinoma, and adrenocortical carcinoma. Bluish skin nodules producing the "blueberry muffin baby"-like appearance were the most common dermatologic finding in 171, or 82% of 208 neonates. The tendency of newborns to present with skin nodules is one of the significant differences between malignancies in younger and older children. Patients with rhabdoid tumor and rhabdomyosarcoma had the lowest survival rates, 4% and 15%, respectively, compared with leukemia, 37.5%, and neuroblastoma, 58%. Overall survival was 39%.
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Affiliation(s)
- Hart Isaacs
- Department of Pathology, Rady Children's Hospital San Diego, San Diego, California 92123, USA.
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13
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Rosa M, Mohammadi A, Campos M, García-García I, Correa-Rivas MS. Congenital EWS/pPNET presenting as a neck mass. Pediatr Blood Cancer 2009; 53:678-9. [PMID: 19492319 DOI: 10.1002/pbc.22073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Frieden IJ, Rogers M, Garzon MC. Conditions masquerading as infantile haemangioma: Part 2. Australas J Dermatol 2009; 50:153-68; quiz 169-70. [DOI: 10.1111/j.1440-0960.2009.00529_1.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Saito Y, Matsuzaki A, Suminoe A, Koga Y, Kurata H, Oda Y, Tsuneyoshi M, Hara T. Congenital Ewing sarcoma in retroperitoneum with multiple metastases. Pediatr Blood Cancer 2008; 51:698-701. [PMID: 18623202 DOI: 10.1002/pbc.21678] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 7-day-old Japanese female showed the absence of spontaneous movement in her both legs. MRI revealed tumors in the retroperitoneum invading into the spinal canal, the left cerebral hemisphere and the right eyeball. Histological examination of retroperitoneal tumor revealed the sheets of undifferentiated small round cells with hyperchromatic nuclei and scanty cytoplasm. EWS-FLI1 fusion gene was detected by RT-PCR, indicating Ewing sarcoma. She received chemo-radiotherapy and survived for 2 years and 10 months despite the multiple metastases at initial presentation.
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Affiliation(s)
- Yusuke Saito
- Department of Pediatrics, Graduate School of Medical sciences, Kyushu University, Fukuoka, Japan
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16
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Cabrera R, Sánchez P, Rodríguez M. Tumor subcutáneo neuroectodérmico primitivo periférico. A propósito de un caso. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74741-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Cabrera R, Sánchez P, Rodríguez MA. [Case report of a subcutaneous peripheral primitive neuroectodermal tumor]. ACTAS DERMO-SIFILIOGRAFICAS 2008; 99:555-9. [PMID: 18682169 DOI: 10.1016/s1578-2190(08)70313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Peripheral primitive neuroectodermal tumors - also known as Ewing sarcomas - are a rare type of malignant tumor the histology of which characteristically reveals the presence of small round cells. Typically, t(11;22) translocation is observed. We describe the case of a 45-year-old man with a subcutaneous peripheral primitive neuroectodermal tumor in which the t(11;22) translocation was detected. He was satisfactorily treated with surgery and radiotherapy.
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Affiliation(s)
- R Cabrera
- Servicio de Dermatología. Complejo Asistencial de León. León. España.
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18
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A case of congenital peripheral primitive neuroectodermal tumor presenting with multiple metastases. J Pediatr Hematol Oncol 2008; 30:36-8. [PMID: 18176178 DOI: 10.1097/mph.0b013e31815cf730] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The report describes a case of a newborn with a huge congenital abdominal peripheral primitive neuroectodermal tumor, with peritoneal dissemination and cutaneous involvement, and discusses literature data. Peripheral primitive neuroectodermal tumor is an exceedingly uncommon tumor in this age group and is characterized by very aggressive behavior and poor prognosis.
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19
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Abstract
The case report by Meazza et al describes the rapidly fatal outcome of a child born with a congenital peripheral primitive neuroectodermal tumor (pPNET). The case report prompted us to ask several questions. (1) Is there such an entity as congenital pPNET? (2) Do translocation-negative Ewing sarcoma family tumors (ESFT) exist? (3) What is the outcome for newborns with congenital ESFT and how does this affect treatment options?
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20
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Wang L, Bhargava R, Zheng T, Wexler L, Collins MH, Roulston D, Ladanyi M. Undifferentiated small round cell sarcomas with rare EWS gene fusions: identification of a novel EWS-SP3 fusion and of additional cases with the EWS-ETV1 and EWS-FEV fusions. J Mol Diagn 2007; 9:498-509. [PMID: 17690209 PMCID: PMC1975108 DOI: 10.2353/jmoldx.2007.070053] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Ewing family tumors (EFTs) are prototypical primitive small round blue cell sarcomas arising in bone or extraskeletal soft tissues in children or adolescents. EFTs show fusions of EWS with a gene of the ETS family of transcription factors, either EWS-FLI1 (90 to 95%) or EWS-ERG (5 to 10%). Rare cases with fusions of EWS to other ETS family genes, such as ETV1, E1AF, and FEV, have been identified, but their clinicopathological similarity to classic EFTs remains unclear. We report four new cases of EFT-like tumors with rare EWS fusions, including two with EWS-ETV1, one with EWS-FEV, and a fourth case in which we cloned a novel EWS-SP3 fusion, the first known cancer gene fusion involving a gene of the Sp zinc finger family. Analysis of these three new cases along with data on nine previously reported cases with fusions of EWS to ETV1, E1AF, or FEV suggest a strong predilection for extraskeletal primary sites. EFT-like cases with fusions of EWS to non-ETS translocation partners are also uncommon but involve the same amino-terminal portion of EWS, which in our novel EWS-SP3 fusion is joined to the SP3 zinc-finger DNA-binding domain. As these data further support, these types of EWS fusions are associated with primitive extraskeletal small round cell sarcomas of uncertain lineage arising mainly in the pediatric population.
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Affiliation(s)
- Lu Wang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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21
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Ehrig T, Billings SD, Fanburg-Smith JC. Superficial primitive neuroectodermal tumor/Ewing sarcoma (PN/ES): same tumor as deep PN/ES or new entity? Ann Diagn Pathol 2007; 11:153-9. [PMID: 17498589 DOI: 10.1016/j.anndiagpath.2006.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primitive neuroectodermal tumor/Ewing sarcoma (PN/ES) is a single clinical, morphologic, and molecular small round cell tumor entity. These are generally found in deep soft tissue or bone of young male patients, with poor behavior. Location in dermis is unexpected; only rare cases are reported. Cases coded as "dermal," "cutaneous," or "skin" PN/ES were retrieved from our consultation files. Only primary dermal cases were included. Those otherwise diagnosed or with incomplete material were excluded. There were 13 dermal PN/ES cases, consisting of 10 women and 3 men. Ages ranged from 2 to 67 years (mean, 28 years). Locations included groin or thigh (4), back or shoulder (3), neck (1), chest (1), scalp (1), forehead (1), hand (1), and foot (1). Most cases were small (0.5-2.3 centimeters) and painful, and persisted for less than 1 year. All were located within the dermis. Three caused pedunculation; 9 also involved superficial subcutis. All but 1 of the metastasizing tumors were round and encapsulated. All were composed of round to oval cells with a vague rosetting pattern, slightly overlapping nuclei, finely stippled chromatin, clear to eosinophilic cytoplasm, and collagenous stroma. Median mitotic activity was 8 per 10 high-power fields. Necrosis was present in three cases. All had globular periodic acid Schiff positivity and distinctive cytoplasmic membrane CD99 reactivity. One case studied was positive for Fli-1. All were negative for leukocyte common antigen, Tdt, CD3, CD20, CD79, CK20, pankeratin, epithelial membrane antigen, chromogranin, neurofilament protein, carcinoembryonic antigen, desmin, actin, diffuse S100 protein, and HMB45. Nine cases with material for reverse transcription-polymerase chain reaction revealed 1 positive type 2 translocation (EWS exon 7 to Fli-1 exon 5), 4 negative, and 4 "unable to amplify." Treatment was by wide excision; 9 received chemotherapy and 6 radiation. Follow-up of 11 (85%) cases revealed the following: 1 metastasis to stomach and death at 3 years; 10 years without disease (median, 9.0 years). Cutaneous PN/ES is a superficial round cell tumor in older women, with better prognosis than deep PN/ES. These may have a hitherto unrecognized variant genetic abnormality.
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MESH Headings
- 12E7 Antigen
- Adolescent
- Adult
- Aged
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Cell Adhesion Molecules/genetics
- Cell Adhesion Molecules/metabolism
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Middle Aged
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/genetics
- Neuroectodermal Tumors/pathology
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/pathology
- Prognosis
- Retrospective Studies
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sex Characteristics
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Vimentin/genetics
- Vimentin/metabolism
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Affiliation(s)
- Torsten Ehrig
- Dermatopathology Laboratory of New England, Meriden, CT 06450, USA
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22
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Srivastava A, Rosenberg AE, Selig M, Rubin BP, Nielsen GP. Keratin-positive Ewing's sarcoma: an ultrastructural study of 12 cases. Int J Surg Pathol 2005; 13:43-50. [PMID: 15735854 DOI: 10.1177/106689690501300106] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (EWS/PNET) is an aggressive neoplasm of bone and soft tissue. Histologically, it is characterized by the presence of small round blue cells, which usually express MIC-2 and FLI-1 immunohistochemically. The most specific feature for diagnosis, however, is cytogenetic or molecular evidence of a consistent abnormality, the t(11;22)(q24;q12), or variants thereof. The immunohistochemical expression of keratins in a significant proportion of these cases has been highlighted in several recent studies. The ultrastructural features of these keratin-positive tumors have not, however, been characterized in detail. In this study we analyzed the ultrastructural features of 12 well-documented EWS/PNETs that stained strongly for pankeratin by immunohistochemistry. Ultrastructurally, the tumor cells contained a few organelles, which included a small number of mitochondria, poorly developed Golgi complexes, free ribosomes, and inconspicuous rough-endoplasmic reticulum. Rudimentary cell junctions were seen in 2 tumors while prominent junctions were observed in the remaining 10. Five tumors contained intracytoplasmic filaments, and definite tonofibrils were identified in 2. Well-developed basal lamina around tumor cells were also demonstrated in 2 tumors. Follow-up information was available for all cases. Seven patients died of disease, 2 are alive with disease, and 3 have no current evidence of disease. The cohort includes 5 patients with a type-1 translocation, which has been associated with a better prognosis in some studies; 4 of these patients have died of their disease, and 1 is alive with recurrent disease. This study shows that keratin-positive EWS/PNETs have evidence of epithelial differentiation ultrastructurally, and may possibly represent a more aggressive subset of the EWS/PNET group of tumors.
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MESH Headings
- Adolescent
- Adult
- Biomarkers, Tumor/analysis
- Bone Neoplasms/chemistry
- Bone Neoplasms/genetics
- Bone Neoplasms/ultrastructure
- Child
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Keratins/analysis
- Male
- Microscopy, Electron, Transmission
- Neuroectodermal Tumors, Primitive, Peripheral/chemistry
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/ultrastructure
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1
- RNA, Neoplasm/analysis
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/chemistry
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/ultrastructure
- Soft Tissue Neoplasms/chemistry
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/ultrastructure
- Transcription Factors/genetics
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Affiliation(s)
- Amitabh Srivastava
- Department of Pathology, Tufts-New England Medical Center, Boston, MA 02114, USA
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23
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Abstract
The authors report an unusual case of an infant presenting with a congenital peripheral primitive neuroectodermal tumor (PPNET) of the left hand refractory to treatment. A newborn girl was born with a large bluish-red mass of 4.5 cm diameter protruding into the palm and the dorsum of the left hand. Tumor biopsy confirmed the diagnosis of PPNET. The initial metastatic workup for the detection of metastases was negative. Four cycles of chemotherapy according to CCSG 7881/POG 8850 regimen B were given. Despite this aggressive chemotherapy the tumor grew to involve the entire left hand. The left hand was amputated, and then two cycles of topotecan/cyclophosphamide were given. Five months later extensive metastases developed, involving the brain, lungs, liver, and skeleton, and the child died at the age of 2.5 years. PPNET presenting at birth is uncommon; presentation in the hand is unusual, and the fact that it did not respond to treatment is still more uncommon.
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Affiliation(s)
- Mohammed El Hayek
- Department of Pediatric Hematology/Oncology, Tawam University Hospital and Faculty of Medicine and Health Sciences, Al Ain, United Arab Emirates.
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24
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Somers GR, Shago M, Zielenska M, Chan HSL, Ngan BY. Primary subcutaneous primitive neuroectodermal tumor with aggressive behavior and an unusual karyotype: case report. Pediatr Dev Pathol 2004; 7:538-45. [PMID: 15547779 DOI: 10.1007/s10024-004-2024-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 05/17/2004] [Indexed: 10/26/2022]
Abstract
Primitive neuroectodermal tumor/Ewing sarcoma (PNET/ES) rarely occurs in the skin and subcutaneous tissues. We present a case of a 16-year-old girl with primary cutaneous and subcutaneous PNET/ES of the abdominal wall. Despite wide local excision and chemotherapy, she rapidly developed cranial bone and brain metastases, followed by lung and skeletal metastases, and died shortly thereafter. The recurrent tumor exhibited light microscopic features of a small, round, blue cell tumor with intracytoplasmic glycogen. Immunohistochemical analysis showed positivity for CD99, CD56, S100, and glial fibrillary acid protein, and ultrastructural features included cytoplasmic glycogen and focal complex interdigitating synaptic junction-like cytoplasmic folds. Cytogenetic analysis of the relapsed tumor showed a complex karyotype: 47,XX,i(1)(q10), der(4)t(4;19) (q33 approximately q35;q13.1), + 8,t(15;17)(q24;p11.2 approximately p12),der(19)t (19;20)(q13.1;p11.2),der(22)t(20;22)(q13;q13). Cytogenetic, interphase fluorescence in situ hybridization, and molecular genetic analyses failed to show t(11:22) (q24;q12) or abnormalities of chromosome region 22q12. The clinical behavior and atypical and complex cytogenetic abnormalities exhibited by the tumor in this patient are unusual and represent the most aggressive end of the clinical spectrum of cutaneous and subcutaneous PNET/ES.
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MESH Headings
- Adolescent
- Biomarkers, Tumor/analysis
- Bone Neoplasms/secondary
- Brain Neoplasms/metabolism
- Brain Neoplasms/secondary
- Chromosome Aberrations
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Lung Neoplasms/secondary
- Microscopy, Electron, Transmission
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/metabolism
- Neuroectodermal Tumors, Primitive, Peripheral/secondary
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/pathology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/metabolism
- Soft Tissue Neoplasms/pathology
- Subcutaneous Tissue/pathology
- Subcutaneous Tissue/ultrastructure
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Affiliation(s)
- Gino R Somers
- Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, M5G 1X8, Toronto, ON, Canada.
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25
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Lee AC, Wong YC, Fung SH, Kwong NS, Tsui KY, Ramsay AD. Congenital sacrococcygeal primitive neuroectodermal tumor. MEDICAL AND PEDIATRIC ONCOLOGY 2000; 34:448-50. [PMID: 10842257 DOI: 10.1002/(sici)1096-911x(200006)34:6<448::aid-mpo15>3.0.co;2-e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A C Lee
- Department of Paediatrics, Tuen Mun Hospital, New Territories, Hong Kong, China.
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