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Kumarasamy S, Garg K, Garg A, Sharma MC, Singh M, Chandra PS, Kale SS. Extra-skeletal intracranial mesenchymal chondrosarcoma: systematic-literature review. Childs Nerv Syst 2024; 40:2723-2733. [PMID: 38762839 DOI: 10.1007/s00381-024-06452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Intracranial mesenchymal chondrosarcoma (IMC) is a rare malignant tumor in pediatric population. IMC can present as extra- or intra-axial lesion in pediatric patients, though the former is commoner causing raised intracranial pressure (ICP). Radiological diagnosis is a challenge in these cases, as is it difficult to differentiate these from other extra-axial neoplasms due to the wide differential diagnosis in pediatric population. We aim to systematically review the literature and present a rare case of extraskeletal intracranial mesenchymal chondrosarcoma treated with safe maximal resection. METHODS A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed and Scopus databases were queried using the search terms, "primary intracranial chondrosarcoma", "extraskeletal mesenchymal chondrosarcoma", "mesenchymal chondrosarcoma" and "pediatric". Presentation, surgical management and outcome of a 15-year-old male with an extraskeletal IMC are also described. RESULTS The search yielded 25 articles which met the inclusion criteria. These published records consisted of 33 IMC cases with mean age at presentation of 9.81 ± 5.2 years (range 2 months to 18 years). Frontal region was the commonest locations (11, 33.3%). Most common presentation was headache (14, 42.4%). All patients underwent surgical intervention: gross total resection (20, 60.6%), subtotal resection (9, 27.3%) and no extent mentioned (4, 12.1%). No adjuvant therapy was received in 15 patients (45.5%). On latest follow-up, 11 patients (33.3%) are on remission, 5 patients (15.2%) are symptom free, 3 patients (9.1%) had recurrence, 2 patients (6.1%) had metastasis and 9 patients (27.3%) expired. CONCLUSION IMC is a rare entity in pediatric population with imaging findings which are non-characteristic leading to its diagnostic challenge. It can masquerade as other extra-axial intracranial neoplasm (meningioma or hemangiopericytoma). Combination of clinico-radiological and pathological examination can help in accurate diagnosis. Safe Maximal resection followed by radiotherapy is the preferred treatment strategy.
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Affiliation(s)
- Sivaraman Kumarasamy
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No 720, CNC, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No 720, CNC, New Delhi, India.
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohanjit Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No 720, CNC, New Delhi, India
| | - Poodipedi Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No 720, CNC, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No 720, CNC, New Delhi, India
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2
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Rainov NG, Haritonov D, Heidecke V. Long-Term Survival after Primary Ewing's Sarcoma of the Skull with Intracranial Extension. J Neurol Surg A Cent Eur Neurosurg 2024; 85:215-220. [PMID: 37939826 DOI: 10.1055/s-0043-1776264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Primary Ewing's sarcoma of the skull is a very rare malignant neoplasm, predominantly occurring in children and adolescents. We describe here the clinical, neuroradiologic, and histopathologic features of a patient with primary Ewing's sarcoma of the skull and discuss the standards of therapy for this type of tumor. CLINICAL PRESENTATION This 18-year-old male patient presented with a primary Ewing's sarcoma of the skull, involving the dura of the frontal and parietal lobes of the left cerebral hemisphere. He was treated with gross total surgical excision of tumor, skull reconstruction, chemotherapy, and irradiation. Twelve years after the surgery, the patient has no evidence of local recurrence or distant metastases. Radical surgical excision of the primary tumor with safety margins is thought to play a role in the favorable clinical course. CONCLUSION The presented case is the longest surviving patient after treatment of primary Ewing's sarcoma of the skull bone. This rare type of tumor may allow better survival rates under adequate management than sarcoma elsewhere in the body.
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Affiliation(s)
- Nikolai G Rainov
- MVZ Wirbelsäulenzentrum München-Taufkirchen, München, Germany
- Department of Neurosurgery, University Hospital Heart and Brain, Pleven, Bulgaria
| | - Dimitar Haritonov
- Department of Neurosurgery, University Hospital Heart and Brain, Pleven, Bulgaria
| | - Volkmar Heidecke
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
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3
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Shaheen A, Bauman G, Cacciotti C, Zelcer S, Ramadan S. Methylation and Molecular Profiling to Aid in Diagnosis and Radiation Treatment for an Intracranial Ewing Sarcoma in a Pediatric Patient: A Case Report. Adv Radiat Oncol 2024; 9:101352. [PMID: 38405311 PMCID: PMC10885575 DOI: 10.1016/j.adro.2023.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 02/27/2024] Open
Affiliation(s)
- Amber Shaheen
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University London, Ontario, Canada
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Chantel Cacciotti
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Shayna Zelcer
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Sherif Ramadan
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, Ontario, Canada
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4
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Ghosh A, Bharat RP, Das S, Kumar A, Sharma MC, Gupta D, Mallick S. A Rare Case of Primary Intracranial Ewing's Sarcoma. Neurol India 2023; 71:1268-1269. [PMID: 38174475 DOI: 10.4103/0028-3886.391339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Adrija Ghosh
- Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Ram Pukar Bharat
- Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Sumanta Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Mallick
- Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
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5
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Ho C, Nael A, Sato M, Crawford JR. Primary intracranial Ewing sarcoma in an infant. BMJ Case Rep 2023; 16:e255110. [PMID: 37640410 PMCID: PMC10462961 DOI: 10.1136/bcr-2023-255110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Clarice Ho
- University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Ali Nael
- Department of Pathology, Children's Hospital of Orange County, Orange, California, USA
- Department of Pathology, University of California Irvine Medical Center, Orange, California, USA
| | - Mariko Sato
- Department of Pediatrics, Children's Hospital Orange County, Orange, California, USA
| | - John Ross Crawford
- Department of Pediatrics, Children's Hospital Orange County, Orange, California, USA
- Department of Pediatrics, University of California Irvine, Irvine, California, USA
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6
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Geng Z, Gao W, Cheng W, Wu A. Primary Intracranial Ewing Sarcoma Invading the Superior Sagittal Sinus with EWSR1-FLI1 Gene Fusion and EWSR1 Gene Mutation: A Case Report and Literature Review. World Neurosurg 2023; 175:1-10. [PMID: 36990350 DOI: 10.1016/j.wneu.2023.03.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Primary intracranial Ewing sarcoma (ES) is an extremely rare intracranial malignant tumor, mostly occurring in children and adolescents. Because of its rarity, the magnetic resonance imaging (MRI) features and treatment strategies of primary intracranial ES are still unclear. METHODS The purpose of this study was therefore to report a case of primary intracranial ES, whose molecular features included both EWSR1-FLI1 (EWS RNA binding protein 1- Friend leukemia integration 1) gene fusion and EWSR1 gene mutation. It is worth noting that this is the first reported case of ES invading the superior sagittal sinus and mostly causing occlusion. At the same time, there were polymorphisms of four drug metabolism-related enzymes in the tumor. Subsequently, we conducted a literature review to characterize the clinical features, imaging findings, pathological features, treatments, and prognoses of primary intracranial ESs. RESULTS A 21-year-old female was admitted to the hospital with headache with nausea and vomiting for 2 weeks. An MRI showed a 3.8 × 4.0 cm large heterogeneous mass in the bilateral parietal lobe with peritumoral edema. The tumor invaded the superior sagittal sinus and mostly caused occlusion of the middle segment of the superior sagittal sinus. The mass was successfully removed using a neuromicroscope. Postoperative pathology indicated a primary intracranial ES. High throughput sequencing (next generation sequencing) showed that there was EWSR1-FLI1 gene fusion and EWSR1 gene mutation in the tumor, with polymorphisms of four drug metabolism-related enzymes and low tumor mutational burden. Subsequently, the patient received intensity modulated radiation therapy. The patient has signed an informed consent form. CONCLUSIONS The diagnosis of primary intracranial ES depended on histopathology, immunohistochemistry staining, and genetic testing. At present, total tumor resection combined with radiotherapy and chemotherapy is the most effective treatment. We report the first case of primary intracranial ES invading the superior sagittal sinus and causing middle segment occlusion, accompanied by EWSR1-FLI1 gene fusion and EWSR1 gene mutation.
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Affiliation(s)
- Ziang Geng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Gao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wen Cheng
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Anhua Wu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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7
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Irfan M, Abdelsamad O, Grezenko H, Patel A, Akram MR. Brain Metastasis With a Solitary Lesion Secondary to Knee Joint Ewing Sarcoma: A Case Report. Cureus 2023; 15:e39612. [PMID: 37384071 PMCID: PMC10299850 DOI: 10.7759/cureus.39612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
Brain metastasis from Ewing sarcoma is rare and can present with various symptoms. We present a 21-year-old female who underwent surgery for Ewing sarcoma of the knee joint and, after six months, was reported with complaints of headache and vomiting. Considering recommended investigations, metastatic Ewing sarcoma of the brain was diagnosed, and a treatment protocol, such as a combination of surgery, chemotherapy, and radiation, was given. Our observation shows this is the first case reported with a solitary metastatic brain lesion associated with Ewing sarcoma.
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Affiliation(s)
- Muhammad Irfan
- Department of Neurosurgery, Nishtar Medical University, Multan, PAK
- Department of Neuroscience, Sheikh Zayed Hospital, Rahim Yar Khan, PAK
| | - Osama Abdelsamad
- Department of Clinical Oncology, Khartoum Oncology Hospital, Khartoum, SDN
- Department of Research, Michigan State University, Michigan, USA
| | - Han Grezenko
- Department of Neuroscience, Barrow Neurological Institute, Phoenix, USA
| | - Anshum Patel
- Department of Internal Medicine, Narendra Modi Medical College, Ahmedabad, IND
| | - Muhammad Rizwan Akram
- Department of Internal Medicine, Sheikh Zayed Medical College, Rahim Yar Khan, PAK
- Department of Internal Medicine, BronxCare Health System, New York, USA
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8
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Guler A, Senol YC. Primary, Dural-based, Ewing sarcoma in a pediatric patient: presentation of a rare tumor entity with literature review. Childs Nerv Syst 2022; 39:1071-1075. [PMID: 36422696 DOI: 10.1007/s00381-022-05767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
Primary Ewing's sarcoma originating from the calvaria bone and/or underlying Dural involvement has been reported relatively rarely in the literature. Those originating from the dura and invading the bone above it in both directions, both towards the brain parenchyma and via the dura, are even rarer. CASE DESCRIPTION: We present a case of a 14-year-old girl with no known focal neurological deficit who presented with the complaint of vertigo for only 2 months. In neuroradiological examination, the left frontoparietal region of the brain showed the presence of a tumor originating from the dura, invading both bone and brain parenchyma. No other tumor location was discovered after radiological examination. Since the patient had a shift in the brain and progressive loss of strength on the right side, the patient was taken to surgery for tumor excision. The frozen result sent per-operatively was consistent with a round blue cell tumor. Adjuvant chemotherapy treatment was given to the patient after the definitive pathology report was compatible with Ewing's sarcoma. CONCLUSION: The patient had an uneventful neurological recovery without permanent neurological deficit. When the patient was kept under close clinical and radiological surveillance 1 year after the operation, no recurrence of the disease was observed. Bone marrow biopsy results and pet computerized tomography results confirmed the case of primary intracerebral Ewing sarcoma. This case illustrates an extremely rare location of primary Ewing's sarcoma with a set of clinical signs and symptoms extremely rare for this location of this rare disease entity.
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Affiliation(s)
- Ali Guler
- Department of Neurosurgery, Ankara Bilkent City Hospital, MH-3 4Th Floor, Ankara, Turkey.
| | - Yigit Can Senol
- Department of Neurosurgery, Ankara Bilkent City Hospital, MH-3 4Th Floor, Ankara, Turkey.
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9
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Mohakud S, Rajasimman AS, Purkait S, Naik S. Intracranial extraosseous dural-based Ewing's sarcoma with fluid-haematocrit levels: imaging findings of a rare tumour. BMJ Case Rep 2022; 15:e247056. [PMID: 35701017 PMCID: PMC9198795 DOI: 10.1136/bcr-2021-247056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
Extraosseous dural-based primary Ewing's sarcoma of the central nervous system is a rare tumour posing a diagnostic challenge. On cross-sectional radiological imaging, the lesion has an extra-axial location with heterogeneous appearance. These lesions are usually multicystic with internal haemorrhage causing fluid-haematocrit levels. It mimics conditions like an aneurysmal bone cyst, microcystic meningioma, telangiectatic osteosarcoma or cystic metastasis. Exclusion of primary Ewing's sarcoma or malignancy elsewhere in the body is required to rule out a secondary. Surgery along with adjuvant chemotherapy and focal radiotherapy is the preferred mode of treatment. Due to the presence of non-specific small round blue cells on H&E stain, these tumours are also confused with lymphoma, osteosarcoma, rhabdomyosarcoma, Merkel cell carcinoma, ependymoblastoma and neuroendocrine carcinoma. Immunohistochemistry provides a definitive diagnosis. A high degree of suspicion in the preoperative scans is crucial for prognostication and early management of this aggressive tumour leading to improved patient survival.
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Affiliation(s)
- Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | | | - Suvnedu Purkait
- Pathology and Lab Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
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10
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Elbaroody M, Abdullah A. Primary intracranial Ewing’s sarcoma/peripheral primitive neuroectodermal tumor in pediatric age group: A comprehensive review of literature. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Primary intracranial Ewing sarcoma/ peripheral primitive neuroectodermal tumor, an entity of unacquaintance: a series of 8 cases. Childs Nerv Syst 2021; 37:839-849. [PMID: 32761378 DOI: 10.1007/s00381-020-04850-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose is to highlight the primary intracranial (meningeal-based) occurrence of Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET). METHODS This report is a collation of clinicopathological features of eight cases of molecularly and clinicoradiologically confirmed primary (non-metastatic) intracranial (non-osseous) meningeal ES/PNET. RESULTS The age range was 1 to 33 years with a median age of 9 years. Male to female ratio was 0.6:1. All patients were diagnosed on the debulking surgical material (gross total resection, 2 cases; subtotal resection, 6 cases) and showed primitive embryonal histomorphology with diffuse membranous CD99 immunoexpression and EWSR1 gene rearrangement by fluorescence in situ hybridization. Seven of them showed a typical FISH pattern of split signals with break-apart probe, while one showed an unusual signal pattern of loss of green signals. EFT-2001 adjuvant protocol was followed along with focal radiotherapy (RT) in all cases (except case 8, full course of chemotherapy could not be completed). Two cases had local recurrence-one of them died of disease recurrence before the administration of further treatment. CONCLUSION This series adds non-osseous intracranial site to the list of uncommon sites of occurrence for ES/PNET and more importantly emphasizes the need to be considered in a differential list of primary intracranial primitive embryonal tumors before embarking as primary central nervous system (CNS) embryonal tumor, NOS.
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12
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Yapıcıer Ö, Nanah AR, Taskapılıoglu MÖ, Demir MK. Intracranial extra-axial mesenchymal chondrosarcoma in a 16-month-old patient with a literature review of pediatric patients. Childs Nerv Syst 2021; 37:649-657. [PMID: 32382867 DOI: 10.1007/s00381-020-04652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
Mesenchymal chondrosarcoma is a rare high-grade malignant subtype of chondrosarcoma that is characterized by undifferentiated, round, or spindled mesenchymal cells, interspersed with islands of hyaline cartilage. We report a primary intracranial extra-axial mesenchymal chondrosarcoma in a 16-month-old patient with a review of the literature focusing on intracranial extra-axial MCs with or without skull involvement in pediatric patients, including differential diagnosis. The patient was admitted with a swelling in the right temporooccipital region. There was intracranial extra-dural extension of the mass, which abuts the neural parenchyma without any invasion. A complete tumor resection was performed. Pathological diagnosis was mesenchymal chondrosarcoma. The patient was free of symptoms after surgery.
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Affiliation(s)
- Özlem Yapıcıer
- Department of Pathology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | | | | | - Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, 11 kisim, Yasemin Apt, D blok, Daire 35 Ataköy, 34158, Istanbul, Turkey.
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13
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Lopez-Nunez O, Cafferata B, Santi M, Ranganathan S, Pearce TM, Kulich SM, Bailey KM, Broniscer A, Rossi S, Zin A, Nasrallah MP, Li MM, Zhong Y, Miele E, Alaggio R, Surrey LF. The spectrum of rare central nervous system (CNS) tumors with EWSR1-non-ETS fusions: experience from three pediatric institutions with review of the literature. Brain Pathol 2020; 31:70-83. [PMID: 32997853 PMCID: PMC8018079 DOI: 10.1111/bpa.12900] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
The group of CNS mesenchymal (non‐meningothelial) and primary glial/neuronal tumors in association with EWSR1‐non‐ETS rearrangements comprises a growing spectrum of entities, mostly reported in isolation with incomplete molecular profiling. Archival files from three pediatric institutions were queried for unusual cases of pediatric (≤21 years) CNS EWSR1‐rearranged tumors confirmed by at least one molecular technique. Extra‐axial tumors and cases with a diagnosis of Ewing sarcoma (EWSR1‐ETS family fusions) were excluded. Additional studies, including anchored multiplex‐PCR with next‐generation sequencing and DNA methylation profiling, were performed as needed to determine fusion partner status and brain tumor methylation class, respectively. Five cases (median 17 years) were identified (M:F of 3:2). Location was parenchymal (n = 3) and undetermined (n = 2) with topographic distributions including posterior fossa (n = 1), frontal (n = 1), temporal (n = 1), parietal (n = 1) and occipital (n = 1) lobes. Final designation with fusion findings included desmoplastic small round cell tumor (EWSR1‐WT1; n = 1) and tumors of uncertain histogenesis (EWSR1‐CREM, n = 1; EWSR1‐CREB1, n = 1; EWSR1‐PLAGL1, n = 1; and EWSR1‐PATZ1, n = 1). Tumors showed a wide spectrum of morphology and biologic behavior. For EWSR1‐CREM, EWSR1‐PLAGL1 and EWSR1‐PATZ1 tumors, no significant methylation scores were reached in the known brain tumor classes. Available outcome (4/5) was reported as favorable (n = 2) and unfavorable (n = 2) with a median follow‐up of 30 months. In conclusion, we describe five primary EWSR1‐non‐ETS fused CNS tumors exhibiting morphologic and biologic heterogeneity and we highlight the clinical importance of determining specific fusion partners to improve diagnostic accuracy, treatment and monitoring. Larger prospective clinicopathological and molecular studies are needed to determine the prognostic implications of histotypes, anatomical location, fusion partners, breakpoints and methylation profiles in patients with these rare tumors.
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Affiliation(s)
- Oscar Lopez-Nunez
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.,Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Barbara Cafferata
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sarangarajan Ranganathan
- Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas M Pearce
- Division of Neuropathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Scott M Kulich
- Division of Neuropathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kelly M Bailey
- Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alberto Broniscer
- Division of Pediatric Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sabrina Rossi
- Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angelica Zin
- Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
| | - MacLean P Nasrallah
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marilyn M Li
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Yiming Zhong
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Alaggio
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lea F Surrey
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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14
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Jiang Y, Zhao L, Wang Y, Liu X, Wu X, Li Y. Primary Intracranial Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor Mimicking Meningioma: A Case Report and Literature Review. Front Oncol 2020; 10:528073. [PMID: 33123461 PMCID: PMC7573284 DOI: 10.3389/fonc.2020.528073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Primary intracranial Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare malignancies, which arise in children and adolescents, with only 9 cases reported in patients over 30 years of age. Due to its rarity, MRI features and treatment strategies for primary intracranial ES/pPNETs remain unclear. The purpose of this study was to explore the clinical features, imaging findings, pathological characteristics, different diagnoses, treatment, and prognosis of cerebellar liponeurocytoma in adults. Case Description: A 55-year-old female was admitted to the hospital with memory decline over 1 month, which aggravated in the last 2 weeks. MRI showed a 4.3 × 6.5 × 3.5 cm heterogeneous large mass in the left frontal lobe with mild peritumoral edema. The mass was successfully removed under neuronavigation and electrophysiological monitoring. The entire mass was removed, and postoperative pathology indicated an ES pPNET diagnosis, with an EWSR1 gene rearrangement. Subsequently, the patient underwent disciplinary radiotherapy. Conclusion: The diagnosis of primary intracranial ES/pPNETs depends on the comprehensive consideration of histological examination, immunohistochemical analysis, and genetic detection. Gross tumor resection combined with radiotherapy and chemotherapy might be the most beneficial treatment.
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Affiliation(s)
- Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Liyan Zhao
- Department of Medical Laboratory, Second Hospital, Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xinrui Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xinmin Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Primary and Metastatic Intracranial Ewing Sarcoma at Diagnosis: Retrospective International Study and Systematic Review. Cancers (Basel) 2020; 12:cancers12061675. [PMID: 32599807 PMCID: PMC7352789 DOI: 10.3390/cancers12061675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022] Open
Abstract
Intracranial Ewing sarcoma (EwS) is rare and publications on primary or metastatic intracranial EwS are minimal. The aim of this study was to describe incidence, clinical behavior, treatment, and factors associated with outcome in patients with primary intracranial EwS or patients with a primary extracranial EwS and cerebral metastases at diagnosis. We reviewed all patients with primary or with metastatic intracranial EwS at diagnosis registered in the International Clinical Trial Euro-E.W.I.N.G.99 (EE99). In total, 17 of 1435 patients (1.2%) presented with primary intracranial EwS; 3 of them had metastatic disease. Four patients (0.3%) with primary extracranial EwS presented with intracranial metastatic lesions. The 3-year event-free survival (EFS) was 64% and overall survival (OS) was 70% in patients with a primary intracranial EwS. Local control in patients with primary intracranial EwS consisted of surgery (6%), radiotherapy (RT) (18%), or both modalities (76%). Univariate analysis showed that patients < 15 years of age had significantly better outcome (EFS: 72%; OS: 76%) compared to those aged above 15 years (EFS: 13%; OS: 25%). In conclusion, primary intracranial EwS and extracranial EwS with cerebral metastases at diagnosis is rare, yet survival is comparable with local and metastatic EwS elsewhere in the body. Age and stage of disease are important prognostic factors. Besides chemotherapeutic treatment, local control with surgical resection combined with RT is recommended whenever feasible.
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Huang J, Ghent F, Levingston R, Scholsem M. Intracranial Ewing Sarcoma - A case report. Surg Neurol Int 2020; 11:134. [PMID: 32547821 PMCID: PMC7294174 DOI: 10.25259/sni_178_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Intracranial Ewing’s sarcoma (ES) is a rare entity with <15 cases reported in the literature. It belongs to a family of round-cell neuroectodermally derived tumors bearing many similarities to peripheral primitive neuroectodermal tumor (pPNET). There is currently no established treatment protocol. Reported cases are treated with either surgery alone or surgery with adjuvant chemotherapy and radiation. Case Description: We describe a case of intracranial left frontal ES in a 19-year-old patient who presented with change in behavior. Diagnosis was unclear based on radiological findings on MRI and CT alone. MRI brain with contrast demonstrated a large extra-axial ovoid heterogeneously enhancing left frontal convexity mass. The patient underwent gross total resection with adjuvant chemotherapy and radiation. No local or systemic recurrence was found at 12 months postoperatively. Conclusion: Intracranial ES/pPNET is rare tumor with nonspecific clinical presentation and radiological findings. They are locally invasive. Surgery with adjuvant chemoradiation is the mainstay treatment. Distinction of pPNET and cPNET is important for therapeutic and prognostic purposes.
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Affiliation(s)
- Jiahua Huang
- Department of Neurosurgery, St. George Public Hospital, Kogarah, New South Wales, Australia
| | - Finn Ghent
- Department of Neurosurgery, St. George Public Hospital, Kogarah, New South Wales, Australia
| | - Robyn Levingston
- Department of Neurosurgery, St. George Public Hospital, Kogarah, New South Wales, Australia
| | - Martin Scholsem
- Department of Neurosurgery, St. George Public Hospital, Kogarah, New South Wales, Australia
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Vishnoi JR, Kumar V, Srivastava K, Misra S. Primary Ewing's sarcoma of the temporal bone: a rare entity and review of the literature. BMJ Case Rep 2019; 12:12/10/e230768. [PMID: 31645395 DOI: 10.1136/bcr-2019-230768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ewing's sarcoma (ES) is the second most common malignant primary bone tumour in children and adolescents. It primarily affects the diaphysis of long bones and pelvis. ES arising from temporal bone is extremely rare. To date, 43 such cases have been described in the literature. Clinical and radiological features are non-specific. Diagnosis is based mainly on immunohistochemistry. The present article presents an extremely rare case of ES of the temporal bone in a 20-year young man, and he was successfully treated with multiagent chemotherapy and radiotherapy.
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Affiliation(s)
- Jeewan Ram Vishnoi
- Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India .,Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kirti Srivastava
- Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Misra
- Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Panagopoulos D, Themistocleous M, Apostolopoulou K, Sfakianos G. Primary, Dural-Based, Ewing Sarcoma Manifesting with Seizure Activity: Presentation of a Rare Tumor Entity with Literature Review. World Neurosurg 2019; 129:216-220. [DOI: 10.1016/j.wneu.2019.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022]
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Choi SW, Ko H. Primary Ewing sarcoma of the squamous temporal bone with intracranial and extracranial extension: A rare cause of sudden sensorineural hearing loss. Head Neck 2018; 41:E38-E41. [DOI: 10.1002/hed.25449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/15/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sung-Won Choi
- Department of Otorhinolaryngology and Biomedical Research Institute; Pusan National University Hospital; Busan Republic of Korea
| | - Hoon Ko
- Department of Pediatrics and Biomedical Research Institute; Pusan National University Yangsan Hospital; Yangsan Republic of Korea
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Clinical Features and Long-Term Outcome of Primary Intracranial Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumors: 14 Cases From a Single Institution. World Neurosurg 2018; 122:e1606-e1614. [PMID: 30496933 DOI: 10.1016/j.wneu.2018.11.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Primary intracranial Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare, and only a few studies have reported >4 cases of this disease. The purpose of this study was to explore the clinical features, treatment, and outcome of primary intracranial ES/pPNETs. METHODS The clinical data of 14 patients who had been surgically treated from February 2003 to November 2017 and in whom immunohistochemical staining results had confirmed the diagnosis of primary intracranial ES/pPNETs were retrospectively analyzed. Kaplan-Meier survival analysis was used to estimate the survival rate and the median survival time (MST). RESULTS Gross total resection (GTR) was achieved in 7 cases, and subtotal resection was performed in 7 cases. During follow-up, 10 (71.4%) patients had local recurrence and 3 (21.4%) patients had distant metastasis. The overall 1-, 2-, and 5-year survival rates were 78.6%, 47.6%, and 19.0%, respectively. Kaplan-Meier survival analysis showed that postoperative radiotherapy was a significant prognostic factor for longer MST (P = 0.034). GTR and radiotherapy with or without adjuvant chemotherapy yielded the highest 2-year survival rate (100%). Three patients who underwent GTR, radiotherapy, and chemotherapy had the highest 2-year survival rates (100%) and the longest MST (48 months). CONCLUSIONS Primary intracranial ES/pPNETs have an aggressive clinical course, with a high tendency for local recurrence and distant metastasis. Radiotherapy plays a significant role in improving the survival of patients. GTR combined with radiotherapy and chemotherapy may be the most beneficial treatment modality.
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