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Fedeli MA, Marras V, Fara AM, Deiana A, Lobrano R, Cossu A, Paliogiannis P. Primary Ewing sarcoma of the lung: A systematic review of the recent literature. Ann Diagn Pathol 2023; 65:152152. [PMID: 37149954 DOI: 10.1016/j.anndiagpath.2023.152152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
Primary pulmonary Ewing sarcoma (PES) is a rare malignancy with only sporadic cases reported in the scientific literature. We performed a systematic review of the cases published in the last decade on PubMed, with the aim to describe the clinical, pathological, therapeutic, and prognostic data of PES. Forty-two articles reporting on 50 cases have been reviewed. Globally, 60 % of the patients were males, and the mean age at diagnosis was 30.5 years, with only a few cases diagnosed after 50 years of age. The most common clinical manifestations at diagnosis were dyspnea, cough and chest pain. The most common immunohistochemistry findings were staining for CD99 and (less frequently) for vimentin, and no staining for TTF-1, cytokeratin, desmin and S-100. ESWR1-FL1 translocation was tested in less than half of the cases. The disease was often locally advanced, treated generally with multidisciplinary treatment combining surgery, chemotherapy and radiation therapy. Among patients with follow-up data, approximately 40 % were dead at the time of publication, with the median survival being 11.5 months. Among those who were alive, only 8.3 % was free from disease at 48 months from diagnosis.
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Affiliation(s)
- Maria Antonietta Fedeli
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Vincenzo Marras
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Antonella Maria Fara
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Angelo Deiana
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Renato Lobrano
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
| | - Antonio Cossu
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
| | - Panagiotis Paliogiannis
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
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2
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Muacevic A, Adler JR, Spanomanolis N, Soumpourou E. Ewing Sarcoma of the Lung: Imaging of a Rare Tumor. Cureus 2022; 14:e32395. [PMID: 36636530 PMCID: PMC9830843 DOI: 10.7759/cureus.32395] [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: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Primary pulmonary Ewing sarcoma is an extremely rare tumor of neuroectodermal tissue. In this article, we report on the case of a 45-year-old female who presented in the emergency department with shortness of breath and night fever. Radiologic findings suggested a massive pulmonary mass and a metastatic liver lesion. The diagnosis of Ewing sarcoma was established through a percutaneous biopsy of the lung mass and liver lesion. We highlight the importance of considering a broad differential diagnosis for a large pulmonary mass in order to lead to a prompt diagnosis and treatment.
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3
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Sohn AJ, Lang B, McCarroll M, Agarwal A. Primary pulmonary Ewing sarcoma/peripheral primitive neuroectodermal tumor. Proc AMIA Symp 2020; 33:646-648. [PMID: 33149376 PMCID: PMC7590833 DOI: 10.1080/08998280.2020.1798723] [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] [Received: 05/16/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022] Open
Abstract
Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) is a malignant small round cell sarcoma commonly occurring among children, adolescents, and adults. We report a rare case of ES/pPNET arising from the lung in a 49-year-old woman. She was found to have a mass in the right lung on a screening imaging study for her BRCA2 mutation. A lobectomy was performed and the mass had histological, immunohistochemical, and molecular features of ES/pPNET. Few cases of primary pulmonary Ewing sarcoma have been reported.
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Affiliation(s)
- Aaron J. Sohn
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Benjamin Lang
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Michael McCarroll
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Atin Agarwal
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
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Takigami A, Yamasawa H, Kurosaki A, Sakamoto N, Onuki T, Mato N, Tetsuka K, Endo S, Niki T, Bando M, Hagiwara K. Pazopanib Confers a Progression-free Survival in a Patient with Ewing's Sarcoma/Primitive Neuroectodermal Tumor of the Lung. Intern Med 2019; 58:1335-1339. [PMID: 30626819 PMCID: PMC6543224 DOI: 10.2169/internalmedicine.1549-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ewing's sarcoma (ES)/primitive neuroectodermal tumors (PNETs) are highly malignant neoplasms that usually affect the bones and soft tissues in children and young adults. ES/PNET of the lung is very rare and is associated with a poor prognosis. We herein report a case of ES/PNET of the left lung in a 45-year-old man. He was treated with neoadjuvant chemotherapy and pneumonectomy, but unfortunately his disease recurred 1.5 months after surgery. He was started on pazopanib, which resulted in a five-month progression-free survival. To our knowledge, this is the first demonstration of pazopanib efficacy in ES/PNET of the lung.
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Affiliation(s)
- Ayako Takigami
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Hideaki Yamasawa
- Department of Pulmonary Medicine, International University of Health and Welfare, Japan
| | - Ayako Kurosaki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Noritaka Sakamoto
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Tsugitoshi Onuki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Naoko Mato
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Japan
| | - Toshiro Niki
- Department of Integrative Pathology, Jichi Medical University, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
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5
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Ewings Sarcoma: A Case of Respiratory Distress and Opacification That Was not Pneumonia. Pediatr Emerg Care 2018; 34:e90-e92. [PMID: 28248841 DOI: 10.1097/pec.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Ewing sarcoma family of tumors typically appears in the second decade of life with regional pain and swelling of a long bone. The following case presents a pediatric patient, aged 4 years, given a diagnosis of Ewing sarcoma of the rib with the initial presentation of respiratory distress, hypoxia, and pleural effusion. Respiratory distress accounts for a large majority of emergency department visits annually, so it is the distinct responsibility of the emergency department physician to avoid premature closure in attributing the most common diagnoses to account for the presenting symptoms. In this case, the careful study of the initial radiographic findings led to further identification and characterization of the mass through thoracic computed tomography to suggest Ewing sarcoma, despite the patient's unlikely demographics and presentation.
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6
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Mizuguchi K, Minato H, Onishi H, Mitani Y, Kawai J. Cytopathological findings of primary pulmonary Ewing family of tumors with EWSR1 translocation: A case report. Thorac Cancer 2016; 7:602-606. [PMID: 27766786 PMCID: PMC5125323 DOI: 10.1111/1759-7714.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/11/2016] [Indexed: 10/27/2022] Open
Abstract
Primary pulmonary neoplasms of the Ewing family of tumors (EFT) are extremely rare and usually occur in adolescents or young adults. Only about 40 cases of pulmonary EFT have been reported in English literature, and no cytological studies have been documented. In this report, we describe the cytopathological findings of a primary pulmonary EFT in an elderly patient. A 70-year-old man sought care because of a progressing cough and dyspnea. Chest computed tomography revealed a circumscribed mass of 6 cm in the left upper lobe. Fine needle aspiration cytology and core needle biopsy revealed uniform round cell proliferation. The predominant population consisted of cells with thickened nuclear membranes, finely dispersed chromatin, single distinct nucleoli, and indistinct cytoplasm. The other population consisted of smaller cells with darker chromatin. The cytoplasm stained positive for periodic acid-Schiff stain and was digested by diastase. Immunohistochemistry showed positivity for MIC2 (CD99), and focal positivity for neuron specific enolase, synaptophysin, and chromogranin A. Fluorescence in situ hybridization (FISH) revealed EWSR1 translocation. Although rare, pulmonary EFT cannot be disregarded, regardless of age. When two populations of uniform, round cells are observed, immunohistochemistry with MIC2 (CD99) and cytogenetic analysis by reverse transcription polymerase chain reaction or FISH should be considered. Cytological diagnosis may play an important role in the early diagnosis and treatment of pulmonary EFT.
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Affiliation(s)
- Keishi Mizuguchi
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
| | - Hiroshi Minato
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hitomi Onishi
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
| | - Yuki Mitani
- Department of Clinical Laboratory, Japan Community Healthcare Organization Kanazawa Hospital, Ishikawa, Japan
| | - Jun Kawai
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
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7
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Shet N, Stanescu L, Deutsch G. Primary extraosseous Ewing sarcoma of the lung: Case report and literature review. Radiol Case Rep 2015; 8:832. [PMID: 27330628 PMCID: PMC4900125 DOI: 10.2484/rcr.v8i2.832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ewing sarcoma is the second most common primary osseous malignancy in children and young adults. However, infrequently, it can arise outside the skeletal system; rarer still, it can originate within the lung parenchyma. In this case report, we describe such a case in a 23-year-old male. We also review the literature to summarize imaging findings for this rare malignancy.
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8
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Deokar KK, Kunjir NG, Ghorpade S. Primary ewings sarcoma of the lung. J Clin Diagn Res 2015; 9:XD01-XD03. [PMID: 25738070 DOI: 10.7860/jcdr/2015/10946.5436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/11/2014] [Indexed: 11/24/2022]
Abstract
Extraosseous ewings sarcoma is an extremely rare neuroectodermal tumour. We report the case of a 30-year-old female who presented with right sided pulmonary mass. Radiology, histopathology and immunohistochemistry confirmed the diagnosis of primary pulmonary Ewings sarcoma. This case highlights the fact that Ewings sarcoma should be considered in differential diagnosis of patients presenting with pulmonary mass.
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Affiliation(s)
- Kunal K Deokar
- Assistant Professor, Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College , Sion, Mumbai, Maharashtra, India
| | - Nana G Kunjir
- Resident, Department of Pulmonary Medicine, Apollo Hospitals , Chennai, Tamilnadu, India
| | - Shivhari Ghorpade
- Professor and Head, Department of Pulmonary Medicine, Govt Medical College , Nagpur, Maharashtra, India
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9
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Hwang SK, Kim DK, Park SI, Kim YH, Kim HR. Primary Ewing's Sarcoma of the Lung. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:47-50. [PMID: 24570867 PMCID: PMC3928264 DOI: 10.5090/kjtcs.2014.47.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 11/16/2022]
Abstract
Most cases of Ewing's sarcoma are reported in the bone, and extraosseous Ewing's sarcoma is an extremely rare disease. Here, we report a rare case of primary pulmonary Ewing's sarcoma in a patient with hemoptysis. The patient underwent right upper lung lobe lobectomy with adjuvant chemotherapy and radiation therapy and has been free of recurrent disease for 4 years.
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Affiliation(s)
- Su Kyung Hwang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
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10
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Barroca H, Souto Moura C, Lopes JM, Lisboa S, Teixeira MR, Damasceno M, Bastos P, Sobrinho-Simões M. PNET with neuroendocrine differentiation of the lung: Report of an unusual entity. Int J Surg Pathol 2013; 22:427-33. [PMID: 24141023 DOI: 10.1177/1066896913502227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (PNET) has been the subject of recent reports describing morphologic variants (adamantinoma-like, large cell, spindle cell, sclerosing, clear cell, and vascular-like) of the most classic form, as well as cases displaying unusual morphologic differentiation and atypical immunohistochemical features. We report a case of an uncommon lung tumor in a 20-year-old female, morphologically and molecularly consistent with an Ewing's sarcoma/PNET tumor with foci of squamous differentiation, and peculiar expression of vimentin, high-molecular-weight keratins, p63, synaptophysin, and chromogranin. This case raises a challenging differential diagnostic problem with therapeutic implications: Should the patient be treated following the protocols for Ewing's sarcoma/PNET tumors or as for lung carcinoma with neuroendocrine features? The patient we report here was treated with neoadjuvant chemotherapy for Ewing's sarcoma/PNET according to Euro Ewing 99 study protocol followed by surgery and has no evidence of disease 15 months after the initial diagnosis. This highlights the importance of achieving the correct diagnosis of these atypical tumors using all clinical, morphological, and ancillary methods available to allow for their correct and timely treatment.
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Affiliation(s)
- Helena Barroca
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Conceição Souto Moura
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Manuel Lopes
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
| | - Susana Lisboa
- Instituto Português de Oncologia do Porto e Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Manuel R Teixeira
- Instituto Português de Oncologia do Porto e Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Margarida Damasceno
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Manuel Sobrinho-Simões
- Centro Hospitalar S João, Porto, Portugal Departamento de Patologia e Oncologia Médica da Faculdade de Medicina da Universidade do Porto, Porto, Portugal Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal
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