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Mousavi SR, Farrokhi MR, Eghbal K, Dehghanian A, Rezvani A, Ghaffarpasand F. Metastatic thoracic and lumbar intramedullary and extramedullary Ewing's sarcoma: a rare case report and literature review. J Int Med Res 2022; 50:3000605221108095. [PMID: 35938475 PMCID: PMC9364211 DOI: 10.1177/03000605221108095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ewing sarcoma (ES) is a highly aggressive bone and soft tissue tumor that occurs
mainly in young children and adolescents and is associated with primary and
metastatic disease. Intramedullary ES (either primary or secondary) is rare, and
the ideal management remains inconclusive. We herein report intramedullary and
extramedullary metastatic ES in a single patient. A 46-year-old woman was
referred to our outpatient clinic from the oncology clinic with progressive
paraparesis and paresthesia for 1 week prior to presentation. She had developed
left clavicular ES 2 years earlier for which surgery and chemoradiotherapy had
been performed. At the present evaluation, she was diagnosed with intramedullary
thoracic and lumbar extradural masses. Thoracic surgery was performed, and a
biopsy of the lesion was obtained. The diagnosis of ES was confirmed
histopathologically, and she underwent adjuvant chemotherapy. Her neurological
status did not improve after surgery, and she underwent rehabilitation and
physical therapy. The lumbar lesion resolved with chemotherapy. Metastasis of ES
to the spinal cord, especially intramedullary lesions, is extremely rare, and
there is no standard management guideline. However, surgical decompression and
adjuvant chemotherapy are the main treatments in these cases.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Trauma research center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Margol A, Abongwa C, Dhall G. Primary Primitive Neuroectodermal Tumor of the Spine With t(11;22): Report of 3 Cases and Review of Literature. J Pediatr Hematol Oncol 2021; 43:e983-e986. [PMID: 33480656 DOI: 10.1097/mph.0000000000002063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
Intradural extramedullary peripheral primitive neuroectodermal tumor (pPNET) with t(11;22) is a rare clinical finding in the pediatric population with few published cases in the literature. The authors report 3 cases of intradural primary pPNET and discuss the clinical presentation, treatment, and survival of the patients. Clinicians should be vigilant in considering pPNET in the differential diagnosis of extradural masses. The authors also compare the clinical course and outcome of therapy with primary PNET of the central nervous system and Ewing sarcoma family of tumors. In addition, this report highlights the risk for leptomeningeal dissemination at recurrence and discusses the importance of central nervous system-targeted therapy for durable disease control.
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MESH Headings
- Adolescent
- Adult
- Bone Neoplasms/diagnosis
- Bone Neoplasms/genetics
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 22/genetics
- Diagnosis, Differential
- Female
- Humans
- Male
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Prognosis
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Spinal Neoplasms/diagnosis
- Spinal Neoplasms/genetics
- Translocation, Genetic
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Affiliation(s)
- Ashley Margol
- Division of Pediatric Oncology, Children's Hospital of Orange County, Orange
| | - Chenue Abongwa
- Division of Pediatric Oncology, Children's Hospital of Orange County, Orange
- Division of Hematology/Oncology and Bone Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Girish Dhall
- Division of Pediatric Oncology, Children's Hospital of Orange County, Orange
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3
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Fukushima K, Tsuji O, Suzuki S, Nori S, Nagoshi N, Okada E, Yagi M, Emoto K, Nakayama R, Watanabe K, Nakamura M, Matsumoto M. Cervical intramedullary recurrent Ewing sarcoma after 10-year disease-free survival in an adult: a case report and review of literature. Spinal Cord Ser Cases 2021; 7:45. [PMID: 34045432 DOI: 10.1038/s41394-021-00406-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Intramedullary metastasis of Ewing sarcoma is extremely rare. Here, we report an adult case of cervical intramedullary recurrent Ewing sarcoma after a 10-year disease-free survival after the initial surgery for a thoracic lesion. CASE PRESENTATION A 39-year-old man with a history of surgery and chemoradiotherapy for thoracic Ewing sarcoma ten years ago presented with neck pain and incomplete motor paralysis in the right upper extremity, which had suddenly appeared three months before. Cervical magnetic resonance imaging revealed a tear-drop-shaped intramedullary lesion at the C3 level accompanied by diffuse edematous change. Because of the rapid progression of his myelopathy, he underwent surgery for this intramedullary lesion. Intraoperatively, the tumor exhibited an orangish exophytic appearance. The unclearness of the tumor boundary compelled us to perform a partial resection. The histopathology showed the tumor comprised small round atypical cells with immunoreactivity for Nkx2.2 and CD99, diagnosing a metastatic Ewing sarcoma. Postoperatively, although his myelopathy improved transiently and adjuvant chemotherapy radiation was undergone, he died of cranial dissemination of the tumor two months and a half later. DISCUSSION To our knowledge, 31 cases of primary and only 4 cases of recurrent intramedullary spinal Ewing sarcoma have been reported to date; however, this is the first case of recurrent intramedullary Ewing sarcoma with a 10-year disease-free survival. Sadly, the prognosis of the current case was extremely poor. There is no clear treatment guideline for recurrent intramedullary Ewing sarcoma because of its rarity, and further collection of similar cases would be required.
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Affiliation(s)
- Keita Fukushima
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Katsura Emoto
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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4
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Feng X, Zhang L, Tan Y, Feng A, Luo F, Xu M, Ye H, Zhu H, Zhou P, Li H. Primitive neuroectodermal tumor of the cervix diagnosed during pregnancy: a rare case report with discussion. BMC Pregnancy Childbirth 2021; 21:382. [PMID: 34006225 PMCID: PMC8132392 DOI: 10.1186/s12884-021-03859-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Primitive neuroectodermal tumor (PNET) is a relatively rare malignant small round cell tumor, and the occurrence of cervical PNET during pregnancy is extremely rare. Case presentation A case of pregnancy complicated by PNET at our hospital was reported. A 19-year-old pregnant woman presented to the hospital due to multiple instances of vaginal bleeding during the first and second trimesters. She was initially considered for threatened abortion but was ultimately diagnosed with cervical PNET. No standard treatment plan has been developed for pregnant women with this tumor. After completing the necessary examinations, doctors cooperated with the patient and her family to develop a surgical treatment plan. The patient recovered well after surgery, but she refused radiotherapy and chemotherapy. After nearly 3 years of follow-up visits, the patient is alive with no signs of recurrence. Conclusions PNET during pregnancy is a rare but complex condition. It is necessary to devise an individualized treatment plan according to gestational age. Timely surgical treatment can significantly prolong the survival time of patients but may also lead to fetal loss and the inability to carry a pregnancy.
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Affiliation(s)
- Xiang Feng
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China.
| | - Lina Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Yanling Tan
- Department of Orthopedics, The First Hospital of YiChang, YiChang, 443000, China
| | - Aihua Feng
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China
| | - Fei Luo
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China
| | - Mengfan Xu
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China
| | - Hong Ye
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China
| | - Hongyu Zhu
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China
| | - Peng Zhou
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, China
| | - Hua Li
- Department of Gynaecology and Obstetrics, The First College of Clinical Medical Science, Three Gorges University, YiChang, 443000, China
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Wei X, Zhang X, Song Z, Wang F. Analysis of Clinical, Imaging, and Pathologic Features of 36 Patients with Primary Intraspinal Primitive Neuroectodermal Tumors: A Case Series and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2021; 82:526-537. [PMID: 33845511 DOI: 10.1055/s-0041-1723810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. MATERIALS AND METHODS We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. RESULTS The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1-60 years), and patients <36 years of age accounted for 83.30% of the study cohort. Progressive limb weakness and numbness were the chief symptoms (accounting for ∼55.6%). The mean complaint duration was 0.89 ± 0.66 months for males and 2.72 ± 3.82 months for females (p = 0.028). Epidural (41.7%) was the most common site, and thoracic (47.3%) was the most frequent location. Most PNETs were peripheral, and magnetic resonance imaging (MRI) appearance was isointense or mildly hypointense on T1-weighted images and hyperintense on T2-weighted images. Homogeneous contrast enhancement was observed. The 1-year survival rate of patients who underwent chemoradiation after total or subtotal lesion resection was better compared with patients who did not undergo chemotherapy, radiotherapy, or total or subtotal resection. The modality of treatment was associated with survival time (p = 0.007). CONCLUSION Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.
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Affiliation(s)
- Xuefeng Wei
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, Republic of China
| | - Xu Zhang
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, Republic of China
| | - Zimu Song
- Department of Neurosurgery, General Hospital Of NingXia Medical University, Yinchuan, Republic of China
| | - Feng Wang
- Department of Neurosurgery, General Hospital Of NingXia Medical University, Yinchuan, Republic of China.,Ningxia Key Laboratory of Cerebrocranial Diseases, Ningxia Medical University, Yinchuan, Republic of China
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Abstract
RATIONALE A primary primitive neuroectodermal tumor (PNET) is a rare and highly malignant tumor that often occurs in the central nervous system of children and young adults. This tumor is rarely observed in the bladder. PATIENT CONCERNS In this paper, we describe the case of a 64-year-old man with a PNET of the bladder. He experienced dull pain in the lower left abdomen for 5 months (without any obvious inducement), which gradually became aggravated and intolerable. DIAGNOSES Partial cystectomy was performed, and a PNET of the bladder, which is extremely rare, was confirmed. INTERVENTIONS Following cystectomy, the patient's general postoperative state was poor and he could not tolerate chemotherapy. Thus, he was subjected to pelvic radiotherapy for 2 weeks. OUTCOMES His physical condition did not improve significantly after radiotherapy; however, we still plan to continue it. If the patient's physical condition improves, chemotherapy will be considered. LESSONS Most cases of PNETs are intravesical or at least mainly endophytic. However, in this case, the mucosal layer was barely involved, and the tumor mainly grew out of the bladder, which is very rare. The present case provides reference for the diagnosis of PNET.
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Affiliation(s)
| | - Dian-Jun Qi
- Department of General Practice, the First Affiliated Hospital of China Medical University
| | - Qing-Fu Zhang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences of China Medical University, Shenyang, PR China
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Mir A, Lashkari M, Jafari F, Molavi B. Primitive Neuroectodermal Tumour Invading the Inferior Vena Cava. Eur J Case Rep Intern Med 2020; 7:001439. [PMID: 32789120 PMCID: PMC7417054 DOI: 10.12890/2020_001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 11/05/2022] Open
Abstract
In the present report, we describe our experience with a 44-year-old male with abnormal retroperitoneal primitive neuroectodermal tumours (PNETs) in our hospital, who was operated on with a spindle cell neoplasm diagnosis. LEARNING POINTS Appropriate treatment is a crucial challenge in patients with PNETs due to late referral.The differential diagnoses were malignant pheochromocytoma, paraganglioma and retroperitoneal sarcoma.Physicians should keep in mind that the patient could be simultaneously suffering from sarcoma and a retroperitoneal PNET.
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Affiliation(s)
- Ali Mir
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jafari
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Molavi
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ganapathy S, Subramaniam V, Baliga V. Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity. Asian J Neurosurg 2020; 15:445-448. [PMID: 32656151 PMCID: PMC7335116 DOI: 10.4103/ajns.ajns_371_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
Rare entities are difficult to predict. They are considered last rightly, to expedite treatment and alleviate symptoms quickly. Rare presentations of rare diseases form a particularly difficult section of diagnoses that are not only impossible to predict but difficult to recognize, diagnose, and treat. Often the dilemma is to, investigate thoroughly saving time but financially burdening the patient and hospital, or, to investigate in gradual increments taking more time and effort, especially in rare cases where prolonged hospitalization and suffering occurs before the diagnosis is reached. This approach, however, wastes critically important time, which, especially in neurological compression, may often lead to irreversible deficits. This dilemma is admirably demonstrated in this case report of spinal Ewing's sarcoma. A young female presented to us with recurrent high cervical epidural collections presenting as compressive myelopathy. She underwent repeated decompressions, and the collection was misdiagnosed as tuberculosis, which was treated without empirical evidence, leading to significant irreversible disability. Finally, when she came to us, the histopathological assessment was done to reveal the diagnosis. Ewing's sarcomas, and indeed the whole gamut of small-round-cell malignancies, are great imitators. They are known to exist in the skull base mimicking schwannomas, chordomas, germinomas, pituitary adenomas, and even epidermoids and occasionally extend to the vertebral bodies and the cranio-vertebral Junction (CVJ) leading to instability and neurological compression. Here, they mimic vertebral tumors, discitis, infective abscesses, and even myeloma. Predictably, such an entity is diagnosed last, and diagnosed late, leading to bad consequences for the patient. Such was the fate of our patient. The report emphasizes the diagnostic dilemma and presents the need to use protocols for diagnosis and treatment, even in rare cases, to effect the best possible outcomes for patients. The use of a thorough diagnostic and management algorhythm prevents deeper and sinister disease processes from being missed.
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Affiliation(s)
- Sibhi Ganapathy
- Department of Neurosurgery, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Venugopal Subramaniam
- Department of Neurosurgery, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Vidya Baliga
- Department of Pathology, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
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Chen J, Li M, Zheng Y, Zheng L, Fan F, Wang Y. Treatment Outcomes and Prognostic Factors of Patients With Primary Spinal Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumors. Front Oncol 2019; 9:555. [PMID: 31293980 PMCID: PMC6603090 DOI: 10.3389/fonc.2019.00555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose: Primary spinal Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare, and the current understanding of these tumors is poor. The authors aimed to illustrate the clinical characteristics of primary spinal ES/pPNETs and to discuss prognostic factors by survival analysis. Methods: A total of 40 patients who were pathologically diagnosed with primary spinal ES/pPNETs between 2000 and 2018 were enrolled in this study. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method to identify potential prognostic factors. Factors of p ≤ 0.1 in the Log-rank tests were subjected to multivariate analysis by Cox regression analysis. Results: The mean follow-up period was 23.8 (range, 2–93) months, and 24 (60.0%) patients had local recurrence and 11 (27.5%) patients had distant metastasis. The 1-, 2-, and 5-year PFS rates were 57.7, 30.4, and 9.5%, respectively. The 1-, 2-, and 5-year OS rates were 74.8, 50.7, and 12.2%, respectively. The univariate analysis suggested that resection mode, postoperative Frankel score, adjuvant chemotherapy and adjuvant radiotherapy were potential prognostic factors for OS and PFS. However, after these factors were subjected to multivariate analyses, only adjuvant radiotherapy and resection mode remained as independent prognostic factors. Conclusions: Total en bloc resection can significantly improve PFS for primary spinal ES/pPNETs and adjuvant radiotherapy was a favorable factor for PFS. Total en bloc resection and adjuvant radiotherapy considerably improve OS for patients with primary spinal ES/pPNETs.
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Affiliation(s)
- Jun Chen
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengxue Li
- Department of Ultrasonics, The 991th Hospital of the Joint Logistics Support Unit of the Chinese People's Liberation Army, Xiangyang, China
| | - Yifeng Zheng
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zheng
- Department of Orthopedics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Fanfan Fan
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Nery B, Pereira LCT, Costa RAF, Queiroz RM, Abud LG, Quaggio E, Coronatto LH, Prado IST, Miyake CH, Filho FB. Cervicomedullary primitive neuroectodermal tumor of the spine: Case report. Surg Neurol Int 2019; 9:241. [PMID: 30595962 PMCID: PMC6287338 DOI: 10.4103/sni.sni_41_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/23/2018] [Indexed: 11/04/2022] Open
Abstract
Background Intramedullary primitive neuroectodermal tumors (PNETs) are tumors found rarely in the cervical region, with only five such cases described in the literature. The available literature contains only one report regarding cervicomedullary junction PNET. Case Description The authors present a case report of a 45-year-old male patient who had undergone urgent hospitalization owing to progressive tetraparesis and subtle impairment of respiratory function. He underwent magnetic resonance imaging, which showed an extensive enhancing cervical intramedullary tumor extending from C5 to the bulbar region. Since he developed severe impairment of respiratory function, he required tracheostomy. He then underwent microsurgery 2 days after his admission, and a partial tumor resection was performed. The pathological diagnosis of PNET of the cervicomedullary junction (CMJ) was made. He had slight worsening of strength after surgery with subsequent deterioration over the next 3 weeks. The tumor displayed aggressive growth; thus, radiotherapy was indicated. Unfortunately, he developed severe febrile neutropenia and died after 2 weeks of radiotherapy. Given the rarity of the condition, we wish to review the epidemiology, pathophysiology, and treatment options of his population. Conclusion Intramedullary PNETs of the cervical spine and CMJ are exceedingly rare in adults; treatment of such patients remains a challenge, despite the modern neurosurgical armamentarium that is available.
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Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Lucas Giansante Abud
- Department of Radiology, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Quaggio
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Fred Bernardes Filho
- Department of Internal Medicine, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
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Chen J, Zheng YF, Tang SC, Zhao YQ, Chen J, Wang Y. Long-term outcomes of surgical resection with or without adjuvant therapy for treatment of primary spinal peripheral primitive neuroectodermal tumors. Clin Neurol Neurosurg 2018; 175:25-33. [PMID: 30312956 DOI: 10.1016/j.clineuro.2018.09.025] [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] [Received: 07/09/2018] [Revised: 08/18/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We sought to assess the use of surgical treatment, the effect of postoperative adjuvant therapy, and the prognostic factors for survival of patients with primary spinal peripheral primitive neuroectodermal tumors (pPNETs). PATIENTS AND METHODS The clinical data of 24 patients, who had been surgically treated from April 2003 to February 2018 and in whom immunohistochemical staining results had confirmed the diagnosis of primary spinal pPNETs, were retrospectively analyzed. To analyze the factors related to prognosis, the Kaplan-Meier method was used for univariate analysis, the log-rank method was used to test the significance of difference, and multivariate analysis was performed using Cox regression. RESULTS The overall 1-year, 2-year, and 5-year survival rates were 73.2%, 48.1%, and 12.0%, respectively. The median survival time (MST) of all patients was 21 months. Univariate analysis showed that the extent of tumor resection, adjuvant radiotherapy, and chemotherapy were the factors influencing patient prognosis after surgery (all P < 0.05); sex, age, tumor location, and preoperative Karnofsky performance scale (KPS) scores were not the influential factors for prognosis of patients after surgery (all P > 0.05). Multivariate analysis showed that gross total resection (GTR) of tumors and adjuvant radiotherapy were independent factors influencing the prognosis of patients with pPNETs (all P < 0.05). CONCLUSIONS Primary spinal pPNETs are extremely rare, and they have a poor prognosis. Microsurgical GTR of the tumor is the preferred method of treatment. Radiotherapy plays an important role in improving the prognosis of patients with pPNETs. GTR combined with radiotherapy and chemotherapy may be the best treatment modality.
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Affiliation(s)
- Jun Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi-Feng Zheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Si-Cheng Tang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi-Qing Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Juan Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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12
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Singh AK, Srivastava AK, Pal L, Sardhara J, Yadav R, Singh S, Bhaisora KS, Das KK, Mehrotra A, Sahu RN, Jaiswal AK, Behari S. Extraosseous Primary Intracranial Ewing Sarcoma/peripheral Primitive Neuroectodermal Tumor: Series of Seven Cases and Review of Literature. Asian J Neurosurg 2018; 13:288-296. [PMID: 29682023 PMCID: PMC5898094 DOI: 10.4103/1793-5482.228570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The Ewing sarcoma peripheral PNET (ES-pPNET) is very rare small round cell tumour that involves the CNS as either a primary dural neoplasm or by direct extension from contiguous bone or soft tissue. Materials and Methods Biopsy proven cases of intracranial ES/pPNET with orbital involvement operated during Jan 2010-Jan 2014 were retrospectively included and their clinical data, operative and histological findings were reviewed from institutional oncology register. Results seven patients (4 males; 3 female) were studied with mean age at presentation of 13 years. Six patients had orbital involvement in one or other form. Surgical excision was gross total in five, near total in one, and subtotal in one patient. All patients received adjuvant therapy, only chemotherapy in 2, only Radiotherapy in four, both in one. MRI characteristics were studied in six patients. Four patients died with average survival of 33.2 months and three patients are having Progression free survival of average 23.3 months. Conclusions The EWS-pPNET is very rare tumour and very poorly described in literature. These tumours are showing special predilection for the frontotemporal dura and erode through the flat bone of cranium like orbital roof and lateral wall of the orbit. These tumours are aggressive, multi compartmental, vascular and very rapidly growing, so missing or overlooking the primary symptoms of dural stretching/bony involvement leads to delay in management and poor outcome.
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Affiliation(s)
- Amit Kumar Singh
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Lily Pal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Rajan Yadav
- Department of Radiotherapy, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Shalini Singh
- Department of Radiotherapy, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Kuntal Kanti Das
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | - Sanjay Behari
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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Abstract
RATIONALE Primary spinal primitive neuroectodermal tumors (PNETs) are highly malignant tumors, which are extremely rare entities and primary intramedullary PNETs are extremely rare. Till now, only 24 cases of primary intramedullary PNET have been reported. PATIENT CONCERNS A 26-year-old male presented with progressive low back and lower limb pain for 1 month. DIAGNOSES Based on MRI and histopathological findings, he was diagnosed with primary intramedullary PNET. INTERVENTIONS The patient was treated two times with microsurgical resections. OUTCOMES Follow-up visit at 14 months after the first surgery showed that the patient is neurologically intact and free of disease. LESSONS PNETs should be considered in the differential diagnosis of an intramedullary spinal cord tumor manifesting as progressive neurological deterioration.
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Affiliation(s)
| | - Fuyou Guo
- Department of Neurosurgery
- Department of Neurosurgery, Key Laboratory of Neurosurgical Diseases, The First Affiliated Hospital of Zhengzhou University, ZhengZhou, HeNan Province, PR China
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14
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Thoriya PJ, Watal P, Bahri NU, Rathod K. Primary spinal primitive neuroectodermal tumor on MR imaging. Indian J Radiol Imaging 2016; 25:459-63. [PMID: 26752826 PMCID: PMC4693396 DOI: 10.4103/0971-3026.169451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neoplasms in the region of filum terminale are not uncommon. Myxopapillary ependymoma is the commonest tumor at this location. The differentials reported for this entity are nerve sheath tumor, meningioma, paraganglioma, intradural metastases, lymphoma, other varieties of ependymoma, subependymoma, astrocytoma, ganglioglioma, hemangioblastoma, and primitive neuroectodermal tumor (PNET). PNET may very rarely present as an intradural thoracolumbar mass. We present pre- and post-therapy magnetic resonance imaging (MRI) features of a patient with proven primary spinal primitive neuroectodermal tumor (PSPNET) of peripheral subtype.
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Affiliation(s)
- Prashant J Thoriya
- Department of Radiodiagnosis, MP Shah Government Medical College, Jamnagar, Gujarat, India
| | - Pankaj Watal
- Department of Radiodiagnosis, MP Shah Government Medical College, Jamnagar, Gujarat, India
| | - Nandini U Bahri
- Department of Radiodiagnosis, MP Shah Government Medical College, Jamnagar, Gujarat, India
| | - Ketan Rathod
- Department of Radiodiagnosis, MP Shah Government Medical College, Jamnagar, Gujarat, India
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15
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Qi W, Deng X, Liu T, Hou Y, Yang C, Wu L, Fang J, Tong X, Yang J, Xu Y. Comparison of Primary Spinal Central and Peripheral Primitive Neuroectodermal Tumors in Clinical and Imaging Characteristics and Long-Term Outcome. World Neurosurg 2015; 88:359-369. [PMID: 26748171 DOI: 10.1016/j.wneu.2015.12.033] [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: 10/31/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Primary spinal primitive neuroectodermal tumors are extremely rare entities. The purpose of this study was to analyze the differences in clinical and imaging characteristics and outcomes between primary spinal central PNETs (cPNETs) and peripheral PNETs (pPNETs). METHODS There were 25 consecutive patients with primary spinal primitive neuroectodermal tumors enrolled. The diagnosis was cPNET in 6 patients with negative CD99 expression and pPNET in 19 patients with positive CD99 expression. Gross total resection (GTR) was achieved in 12 patients, subtotal resection was performed in 9 patients, and partial resection was performed in 4 patients. Postoperative chemotherapy was given to 14 patients, and radiotherapy was given to 16 patients. RESULTS The age at diagnosis was significantly younger in the cPNET group (mean 12.8 years) compared with the pPNET group (mean 22.5 years) (P = 0.040); the 2 pathologies did not show a significant difference in prognosis. GTR (P = 0.041), radiotherapy (P = 0.008), and GTR with radiotherapy (P = 0.009) were significant factors leading to a higher 2-year survival rate. Kaplan-Meier analysis showed that radiotherapy (P < 0.001) and GTR with radiotherapy (P = 0.040) resulted in a longer median survival time. Patients who underwent GTR, chemotherapy, and radiotherapy all together had the highest 1-year (100.0%) and 2-year (71.4%) survival rates and the longest median survival time (32 months). CONCLUSIONS Patients with spinal cPNETs were younger compared with patients with pPNETs. The prognosis of spinal cPNETs and pPNETs was poor with no significant difference between the entities. The most beneficial treatment modality is GTR combined with adjuvant radiotherapy and chemotherapy.
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Affiliation(s)
- Wei Qi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tie Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingzhi Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chenlong Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyi Fang
- Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xianzeng Tong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yulun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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16
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Peripheral facial palsy, the only presentation of a primitive neuroectodermal tumor of the skull base. Int J Surg Case Rep 2015; 19:47-50. [PMID: 26710328 PMCID: PMC4756191 DOI: 10.1016/j.ijscr.2015.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/12/2015] [Accepted: 12/13/2015] [Indexed: 11/28/2022] Open
Abstract
A 2-month-old male infant presenting with only peripheral facial palsy was diagnosed with a primitive neuroectodermal tumor of the skull base. Primitive neuroectodermal tumors located in the skull base are rarely detected in infants. After subtotal resection of the tumor, asymmetrical facial expression showed mild improvement.
Introduction Peripheral facial palsy is rarely caused by primary neoplasms, which are mostly constituted of tumors of the central nervous system, head and neck, and leukemia. Presentation of case A 2-month-old male infant presented with asymmetric facial expression for 3 weeks. Physical examination revealed suspicious findings of right peripheral facial palsy. Computed tomography of the temporal bone revealed a suspicious bone tumor centered in the right petrous bone involving surrounding bones with extension into the middle ear cavity and inner ear. Subtotal resection of the tumor was performed due to crucial structures adjacent the mass. Histopathology and immunohistochemistry of the resected tumor was consistent with primitive neuroectodermal tumor. Conclusion We report a rare case of a primitive neuroectodermal tumor located at the skull base presenting with only peripheral facial palsy.
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17
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Clinical presentation and long-term outcome of primary spinal peripheral primitive neuroectodermal tumors. J Neurooncol 2015; 124:455-63. [PMID: 26186903 DOI: 10.1007/s11060-015-1859-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/12/2015] [Indexed: 12/25/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare entities that predominantly occur in children and young adults. Few studies have reported more than three cases. There are no current optimum treatment strategies due to the paucity of data. Here, we present 13 patients (nine females and four males) with primary intraspinal pPNETs who were surgically treated from April 2008 to February 2014. Histopathologic findings revealed the expression of CD99 in all cases. Limb weakness was the most common initial symptom (11/13, 85 %). The tumors were located mainly at the cervical level (6/13, 46 %) and in the epidural space (10/13, 77 %). The radiological diagnosis was neurinoma or meningioma in most cases (10/13, 77 %). Gross total resection was achieved in 77 % (10/13) of patients. During a mean follow-up of 25.5 months, local relapse occurred in 8 (61.5 %) patients and distant metastases occurred in 8 (61.5 %) patients. The overall 1-year survival rate was 77 % (10/13), and the overall 2-year survival rate was 54 % (7/13). The 2-year survival rate was 57.1 % in patients with adjuvant chemotherapy and 50 % in those without chemotherapy. Gross total resection and adjuvant radiotherapy with or without chemotherapy demonstrated a longer survival period (1-year survival rate: 100 %; 2-year survival rate: 86 %). Our data showed that primary spinal pPNETs are extremely rare and aggressive tumors with a poor prognosis. Radical resection is advocated. Gross total resection combined with adjuvant radiation may help to significantly improve patient survival period. Chemotherapy may also help to slightly prolong patient life.
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18
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A Unique Case of Primary Ewing's Sarcoma of the Cervical Spine in a 53-Year-Old Male: A Case Report and Review of the Literature. Case Rep Med 2015; 2015:402313. [PMID: 25802527 PMCID: PMC4352905 DOI: 10.1155/2015/402313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/10/2015] [Indexed: 02/07/2023] Open
Abstract
Extraskeletal Ewing's sarcoma (EES) is a rare presentation, representing only 15% of all primary Ewing's sarcoma cases. Even more uncommon is EES presenting as a primary focus in the spinal canal. These rapidly growing tumors often present with focal neurological symptoms of myelopathy or radiculopathy. There are no classic characteristic imaging findings and thus the physician must keep a high index of clinical suspicion. Diagnosis can only be definitively made by histopathological studies. In this report, we discuss a primary cervical spine EES in a 53-year-old man who presented with a two-month history of left upper extremity pain and acute onset of weakness. Imaging revealed a cervical spinal canal mass. After undergoing cervical decompression, histopathological examination confirmed a diagnosis of Ewing's sarcoma. A literature search revealed fewer than 25 reported cases of primary cervical spine EES published in the past 15 years and only one report demonstrating this pathology in a patient older than 30 years of age (age = 38). Given the low incidence of this pathology presenting in this age group and the lack of treatment guidelines, each patient's plan should be considered on a case-by-case basis until further studies are performed to determine optimal evidence based treatment.
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19
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Chan SHS, Tsang DSF, Wong VCN, Chan GCF. Spinal primitive neuroectodermal tumor mimicking as chronic inflammatory demyelination polyneuropathy: a case report and review of literature. J Child Neurol 2015; 30:254-8. [PMID: 24659733 DOI: 10.1177/0883073814527160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a young boy who presented with progressive weakness of lower extremities associated with areflexia and abnormal electrophysiological findings initially suggestive of chronic inflammatory demyelinating polyneuropathy. Initial lumbosacral spinal magnetic resonance imaging (MRI) showed thickened descending spinal nerve roots only. Immunomodulating therapy was given but with limited clinical response. Repeated spine magnetic resonance imaging showed cauda equina and also new spinal cord extramedullary contrast enhancement. The initial extensive investigations including open biopsy did not point to any specific diagnosis. Only through pursuing a repeated biopsy, the diagnosis of the spinal peripheral primitive neuroectodermal tumor was confirmed. This case highlights the diagnostic challenges of the spinal peripheral primitive neuroectodermal tumor that could have an initial chronic inflammatory demyelinating polyneuropathy-like presentation. The literature review confirms that this is a rare condition and cauda equina origin has only been reported in adults and teenagers, and this is the first reported case in a young child.
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Affiliation(s)
- Sophelia H S Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Dickson S F Tsang
- Department of Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Virginia C N Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Godfrey C F Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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20
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Meng XT, He SS. Primitive neuroectodermal tumor in the spinal canal: A case report. Oncol Lett 2015; 9:1934-1936. [PMID: 25789071 PMCID: PMC4356409 DOI: 10.3892/ol.2015.2907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 01/08/2015] [Indexed: 12/16/2022] Open
Abstract
Primitive neuroectodermal tumors (PNETs) are rare tumors of uncertain histogenesis that occur predominantly in children and young adults. The current study reports a case of PNET in a 60-year-old female, which presented clinically as an intraspinal tumor, causing symptoms of lower back pain, numbness and pain in the right lower extremity. The patient underwent tumorectomy. Following primary therapy, the symptoms of spinal cord compression were relieved. The patient underwent several courses of radiotherapy following surgery but refused to continue with chemotherapy. After a further four months, the tumors recurred and the patient succumbed to the disease.
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Affiliation(s)
- Xiao-Tong Meng
- Department of Orthopaedics, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai 200072, P.R. China
| | - Shi-Sheng He
- Department of Orthopaedics, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai 200072, P.R. China
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21
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Cole M, Parajuli S, Laske D, Goldstein L, Morrison T, Mukherjee A, Tumelty K, Tetzlaff E, von Mehren M, Inniss S. Peripheral primitive neuroectodermal tumor of the dura in a 51-year-old woman following intensive treatment for breast cancer. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:294-9. [PMID: 25045413 PMCID: PMC4102603 DOI: 10.12659/ajcr.890656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
PATIENT Female, 51. FINAL DIAGNOSIS Ewing sarcoma. SYMPTOMS Visual disturbances. MEDICATION -. CLINICAL PROCEDURE -. SPECIALTY Oncology. OBJECTIVE Rare disease. BACKGROUND Primitive neuroectodermal tumor/Ewing sarcoma (PNET/EWS) is a round blue cell sarcoma that shows varying degrees of neuroectodermal differentiation. PNET/EWS as a primary intracranial tumor is extremely uncommon. CASE REPORT We report a unique case of peripheral PNET presenting as an intracranial mass in an adult following chemotherapy and radiotherapy for a solid tumor. A 51-year-old woman with previously treated left breast cancer was evaluated for a newly developed brain mass. She underwent craniotomy with resection. Surgical pathology was consistent with a peripheral PNET/EWS with Ewing sarcoma gene translocation. She was treated appropriately with vincristine, cyclophosphamide, and doxorubicin (later dactinomycin) alternating with ifosfamide and etoposide. CONCLUSIONS Although development of PNET/EWS presenting along the CNS is exceedingly rare in adults, establishing the proper diagnosis of this "small blue cell tumor" is critical. The further distinction between central PNET and peripheral PNET can greatly impact both prognosis and treatment. Our case also highlights the importance of considering the impact of prior intensive therapies, including radiation and chemotherapy, on predisposing to future PNET/EWS.
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Affiliation(s)
- Marion Cole
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Shobha Parajuli
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, U.S.A
| | - Douglas Laske
- Department of Neurosurgery, Temple University School of Medicine, Philadelphia, PA, U.S.A
| | - Lori Goldstein
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Tara Morrison
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Abir Mukherjee
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, U.S.A
| | - Kathryn Tumelty
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Eric Tetzlaff
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Susan Inniss
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, U.S.A
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22
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Huang WY, Tan WL, Geng DY, Zhang J, Wu G, Zhang BY, Li YX, Yin B. Imaging findings of the spinal peripheral Ewing's sarcoma family of tumours. Clin Radiol 2014; 69:179-85. [DOI: 10.1016/j.crad.2013.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/10/2013] [Accepted: 09/12/2013] [Indexed: 11/15/2022]
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23
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Ghanta RK, Koti K, Ghanta VSK, Teegala R. Intracranial metastasis from primary spinal primitive neuroectodermal tumor. Asian J Neurosurg 2013; 8:42-7. [PMID: 23741262 PMCID: PMC3667460 DOI: 10.4103/1793-5482.110279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumors (PNET) are rare tumors, with only 94 cases reported till date. Metastasis to brain from a spinal PNET is even rarer. In the present report, we evaluate the pathology and treatment of solitary intracranial metastasis from spinal PNET in a 22-year-old female who presented with headache and left hemiparesis and was diagnosed to have right parietal parasagittal tumor. She has been previously diagnosed to have cervicothoracic primary spinal PNET, and was treated by surgery, radiotherapy, and chemotherapy seven years back. The intracranial tumor has been removed and pathological examination confirmed as PNET. She received radiotherapy and chemotherapy with ifosfamide and etoposide, following surgery for the right parietal PNET. At 20 months follow-up, patient is stable and has no recurrence of the disease. Critical review of reported cases of primary spinal PNET metastsising to brain was done.
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Affiliation(s)
- Rajesh Kumar Ghanta
- Department of Neurosurgery, Suraksha Hospital, Vijayawada, Andhra Pradesh, India
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24
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Alexiou GA, Siozos G, Stefanaki K, Moschovi M, Prodromou N. Intramedullary spinal cord primitive neuroectodermal tumor presenting with hydrocephalus. J Child Neurol 2013; 28:246-50. [PMID: 22532539 DOI: 10.1177/0883073812441061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spinal primitive neuroectodermal tumors are exceedingly rare. Herewith, we present the first case of an intramedullary spinal cord tumor associated with hydrocephalus in a 2-month-old boy that presented with left hemiparesis. The patient had been diagnosed on prenatal ultrasound with enlarged ventricular system. At his current admission, a brain magnetic resonance imaging (MRI) revealed hydrocephalus and an intramedullary lesion extending from the second cervical to the first thoracic vertebrae. Dissemination of the tumor was revealed intracranially and in the spinal canal. After a ventriculoperitoneal shunt placement a radical resection of the tumor was performed, however some small tumor remnants could not be safely removed. Postoperative there was no neurologic deterioration. The tumor was diagnosed as a central nervous system primitive neuroectodermal tumor (World Health Organization grade IV). Spinal intramedullary primitive neuroectodermal tumors are extremely rare. In such rare tumors, multiinstitutional studies are needed for treatment guidelines to be established.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, Children's Hospital Agia Sofia, Athens, Greece.
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25
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Alexiou GA, Sfakianos G, Dimitriadis E, Stefanaki K, Anastasopoulos J, Matsinos G, Prodromou N. Spinal dumbbell-shaped peripheral primitive neuroectodermal tumor in a child. Pediatr Neurosurg 2013; 49:119-20. [PMID: 24401730 DOI: 10.1159/000356932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 10/29/2013] [Indexed: 12/25/2022]
Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, Children's Hospital 'Agia Sofia', Athens, Greece
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26
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Primary spinal primitive neuroectodermal tumour: report of two cases mimicking neurofibroma and review of the literature. Neurol Neurochir Pol 2012; 46:480-8. [PMID: 23161193 DOI: 10.5114/ninp.2012.31360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary spinal primitive neuroectodermal tumours (PNETs) are a rare entity. Most of them occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. We present two cases of primary spinal PNET. In both cases, the tumours were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. These tumours are highly aggressive with rapid growth as evidenced by the short history in both of our cases. Both cases underwent gross total removal of the intraspinal and thoracic components. Postoperatively, both patients underwent cranio-spinal radiotherapy. A review of the literature shows that the overall prognosis of PNETs of the spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. One patient died after 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.
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27
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Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are rare tumors. Most of these tumors occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. These tumors are highly aggressive with rapid growth. Review of the literature shows that the overall prognosis of PNETs of spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. All the cases reported to date are reviewed in terms of surgical treatment, adjuvant therapy and outcome and the experience with two of these cases are described. Both cases were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. Both cases underwent gross total removal of intraspinal and thoracic component. Post-operatively both underwent cranio-spinal radiotherapy. One patient died after a post-operative period of 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.
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Affiliation(s)
- Ashis Patnaik
- Department of Neurosurgery, SCB Medical College & Hospital, Cuttack, Odisha, India.
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28
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Harbhajanka A, Jain M, Kapoor SK. Primary spinal intramedullary primitive neuroectodermal tumor. J Pediatr Neurosci 2012; 7:67-9. [PMID: 22837786 PMCID: PMC3401662 DOI: 10.4103/1817-1745.97631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Though primitive neuroectodermal tumor has been considered to arise from a neoplastic transformation of primitive neuroepithelial cells with propensity to involve any part of the central nervous system, a primary intramedullary spinal primitive neuroectodermal tumor is very unusual. The authors describe a case of an 18-year-old female with conus intramedullary tumor diagnosed to be primary spinal primitive neuroectodermal tumor following histopathological examination after surgery. The diagnosis of such a tumor is very crucial as the management strategies for these are relatively unclear and are associated with a poorer outcome compared to the other common intramedullary spinal tumors.
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Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
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29
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Saeedinia S, Nouri M, Alimohammadi M, Moradi H, Amirjamshidi A. Primary spinal extradural Ewing's sarcoma (primitive neuroectodermal tumor): Report of a case and meta-analysis of the reported cases in the literature. Surg Neurol Int 2012; 3:55. [PMID: 22629492 PMCID: PMC3356992 DOI: 10.4103/2152-7806.96154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/22/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Primary spinal primitive neuroectodermal tumors (PNET) and/or spinal extraskeletal Ewing's sarcoma family tumors (ESET) are rare lesions appearing in the spinal extradural space. One hundred forty-one primary spinal PNETs, including 29 intramedullary lesions, have been reported in the literature. Encountering a case of primary epidural EES/peripheral PNET (pPNET) in sacral level, which is the fifth one occurring at this level in the literature, we have tried to conduct a meta-analysis of the reported cases. Case Description: A 44-year-old lady with epidural EES/pPNET is reported here. She was once operated for L5/S1 herniated disc, which did not ameliorate her symptoms. The clinical, imaging, surgical, and histopathologic characteristics of our case are presented and wide search of the literature is also done. All the reports were level 3 or less evidences and most of the series had missing parts. 106 cases of primary intraspinal (extradural/extramedullary-intradural) EES/pPNET and 29 cases of primary intramedullary PNET (CNS-PNET) have been reported in the literature. The most common clinical presentation in both entities was muscle weakness proportionate to the tumor location. Distant metastasis occurred in 38 of 99 (38%) cases of primary intraspinal EES/pPNET, while the rate of metastasis was 48% in patients with PNETs occurring in the intramedullary region (P > 0.05). One-year survival rate of the patients who underwent chemo-radiation after total or subtotal resection was better than those who did not receive chemotherapy or radiotherapy, or did not have total or subtotal resection. However, this difference was not repeated in 2-year survival rate in any of the tumor groups. Conclusion: It seems that total or subtotal removal of the tumor and adjuvant chemo- and radiation therapy can improve the outcome in these patients.
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Affiliation(s)
- Saeed Saeedinia
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Wu G, Ghimire P, Zhu L, Baral A, Su J. Magnetic resonance imaging characteristics of primary intraspinal peripheral primitive neuroectodermal tumour. Can Assoc Radiol J 2012; 64:240-5. [PMID: 22575593 DOI: 10.1016/j.carj.2012.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 10/19/2011] [Accepted: 01/16/2012] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of our study was to describe the salient magnetic resonance imaging (MRI) findings in primary intraspinal peripheral primitive neuroectodermal tumour (PNET). METHODS A retrospective review of the clinical and MRI images of 7 pathologically proven cases of intraspinal peripheral PNETs was performed. The various parameters, such as vertebral level of involvement; tumour location, size, focality, and margin; signal intensity of the lesion; the presence of hemorrhage or calcification; any signal voids; assessment of the adjacent cord for cord compression; cord dilatation; the presence of paraspinal tissue mass; or vertebral or other bony changes, were analysed. RESULTS All 7 patients had lesions in the thoracolumbar region. Three patients had extradural lesions, 4 had intradural extramedullary lesions, and none had intramedullary lesions. Six lesions were well circumscribed. Only 1 patient had multifocal involvement. All lesions were of hypointense or isointense signal on T1-weighted imaging, whereas all but one were hyperintense on T2-weighted imaging. Lesions enhanced heterogeneously except 1 intradural extramedullary lesion, which enhanced homogeneously. A paraspinal mass was noticed in 2 patients. Vertebral collapse was present in 1 patients. CONCLUSION Intraspinal peripheral PNETs are rare spinal tumours. Although imaging characteristics are not specific, a focal circumscribed lesion in a young individual at the intramedullary, extramedullary intradural, or extradural spinal location that shows hypointense and hyperintense signal on T1- and T2-weighted images, respectively, requires PNET to be considered in the differentials.
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Affiliation(s)
- Guangyao Wu
- Department of MRI, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, PR China.
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31
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Abstract
Spinal primitive neuroectodermal tumor (PNET) is rare. We present clinical, radiologic profile and treatment outcome of 15 spinal PNET patients from June 2003 to March 2010 treated with chemoradiotherapy. Median duration of backache was 6.5 months; all had features of myelopathy and/or radiculopathy; 5/15 (33.3%) patients were diagnosed initially as spinal tuberculosis. The event-free survival (EFS) was 24.73% at a median follow-up of 22 months. Complete functional recovery to treatment significantly predicted better EFS; 4 patients discontinued treatment because of poor functional recovery. It is important to recognize spinal PNET early to prevent permanent neurological damage, which in turn would improve compliance, quality of life, and perhaps EFS.
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Coumans JVC, Walcott BP, Nahed BV, Oh KS, Chi AS. Multimodal Therapy of an Intramedullary Cervical Primitive Neuroectodermal Tumor in an Adult. J Clin Oncol 2012; 30:e15-8. [DOI: 10.1200/jco.2011.38.6474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Brian P. Walcott
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Brian V. Nahed
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kevin S. Oh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew S. Chi
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Mulholland CB, Barkhoudarian G, Cornford ME, McBride DQ. Intraspinal primitive neuroectodermal tumor in a man with neurofibromatosis type 1: Case report and review of the literature. Surg Neurol Int 2011; 2:155. [PMID: 22140640 PMCID: PMC3228383 DOI: 10.4103/2152-7806.86835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 08/18/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The occurrence of primitive neuroectodermal tumors (PNET) in patients with neurofibromatosis type 1 (NF1) has only been reported in two other cases in English-Language literature. Owing to the rarity of intraspinal PNET and the extremely high gene mutation variability in NF1, there is currently no conclusive evidence to suggest that PNET is associated with NF1. Here, we report a case of intradural PNET in a patient with NF1. CASE DESCRIPTION A 27-year-old male underwent a C1-C3 laminectomy for resection of an intramedullary mass. Histopathology and immunohistopathology analysis was performed. Microscopic examination and immunohistochemical staining indicated the mass was a primitive neuroectodermal tumor. Within 1 month after tumor resection, the patient developed leptomeningeal carcinomatosis. The patient was not a candidate for radiation therapy but underwent palliative systemic chemotherapy. He subsequently developed neutropenia and died 3 months after tumor resection. CONCLUSION To our knowledge, this is the first reported intraspinal PNET associated with NF1. Genetic analysis of CNS PNETs suggests a possible correlation, but larger case series are needed to support this theory.
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Yan Y, Xu T, Chen J, Hu G, Lu Y. Intraspinal Ewing's sarcoma/primitive neuroectodermal tumors. J Clin Neurosci 2011; 18:601-6. [PMID: 21414790 DOI: 10.1016/j.jocn.2010.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
Intraspinal Ewing's sarcoma (ES) and primitive neuroectodermal tumors (PNET) are very rare, and the characteristics and prognoses of the disease remain unclear. We present an illustrative patient with an intradural, extramedullary PNET arising within the cervical spinal canal, with clinical and radiological manifestations of leptomeningeal spread, and review the reports of a further 77 patients with intraspinal ES/PNET. Cox regression analyses showed that tumor location (extradural, intradural) (p=0.002, RR=4.217, 95% confidence interval [CI] 1.668-10.664) and spinal segment location (cervical, thoracic, lumbar, or sacral) (p=0.017, RR=2.040, 95% CI 1.133-3.673) were independent factors in the prognosis of intraspinal ES/PNET. We concluded that a peripheral PNET may originate within the spinal canal and exhibit leptomeningeal spread similar to that seen in central PNET, and that a patient with an intradural ES/PNET high in the spinal canal is more likely to have a poor prognosis.
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Affiliation(s)
- Yong Yan
- Department of Neurosurgery, Changzheng Hospital, Neurosurgery Research Institution of Shanghai, 415 Fengyang Street, Huangpu District, Shanghai 200003, China
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35
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Shimosawa H, Matsumoto M, Yabe H, Mukai M, Toyama Y, Morioka H. Primary primitive neuroectodermal tumor of the conus medullaris in an elderly patient: a case report and review of the literature. Case Rep Oncol 2011; 4:267-74. [PMID: 21734881 PMCID: PMC3124460 DOI: 10.1159/000323263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are very rare conditions. Most of these tumors occur in children and young adults. A 63-year-old man with a primary spinal PNET in the conus medullaris from the L1 to L2 level is presented in this report. The optimal treatment of primary spinal PNETs is yet unknown. Surgical resection, radiation therapy, and chemotherapy have been advocated for the treatment of spinal PNET based on PNETs at other sites. However, the outcome is very poor. There are a few reports of cases with long-term survival and no recurrence. In these patients, en bloc resections were performed.
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Affiliation(s)
- H Shimosawa
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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36
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Ellis JA, Rothrock RJ, Moise G, McCormick PC, Tanji K, Canoll P, Kaiser MG, McCormick PC. Primitive neuroectodermal tumors of the spine: a comprehensive review with illustrative clinical cases. Neurosurg Focus 2011; 30:E1. [PMID: 21194274 DOI: 10.3171/2010.10.focus10217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are uncommon malignancies that are increasingly reported in the literature. Spinal PNETs, like their cranial counterparts, are aggressive tumors and patients with these tumors typically have short survival times despite maximal surgery, chemotherapy, and radiation. Because no standard management guidelines exist for treating these tumors, a multitude of therapeutic strategies have been employed with varying success. In this study the authors perform a comprehensive review of the literature on primary spinal PNETs and provide 2 new cases that highlight the salient features of their clinical management.
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Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
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37
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The Evaluation of CD99 Immunoreactivity and EWS/FLI1 Translocation by Fluorescence in situ Hybridization in Central PNETs and Ewing’s Sarcoma Family of Tumors. Pathol Oncol Res 2011; 17:619-25. [DOI: 10.1007/s12253-010-9358-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 12/29/2010] [Indexed: 11/27/2022]
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38
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FUJISAWA H, KANEKO T, TOHMA Y, KIDA S, KAIZAKI Y. Central Nervous System Primitive Neuroectodermal Tumor of Spinal Cord Developing 20 Years After Curative Treatment of Pineal Tumor -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:596-9. [DOI: 10.2176/nmc.51.596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Takuro KANEKO
- Department of Neurosurgery, Fukui Prefectural Hospital
| | - Yasuo TOHMA
- Department of Neurosurgery, Fukui Prefectural Hospital
| | - Shinya KIDA
- Department of Neurosurgery, Fukui Prefectural Hospital
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39
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Benesch M, Sperl D, von Bueren AO, Schmid I, von Hoff K, Warmuth-Metz M, Ferrari R, Lassay L, Kortmann RD, Pietsch T, Rutkowski S. Primary central nervous system primitive neuroectodermal tumors (CNS-PNETs) of the spinal cord in children: four cases from the German HIT database with a critical review of the literature. J Neurooncol 2010; 104:279-86. [PMID: 21181235 DOI: 10.1007/s11060-010-0485-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/29/2010] [Indexed: 12/23/2022]
Abstract
Approximately 30-50% of patients with intracranial primitive neuroectodermal tumors (PNETs) of the central nervous system (CNS) develop spinal metastases. In contrast, primary spinal CNS-PNETs are extremely uncommon. The database and study records of the German/Austrian brain tumor trials HIT 91, HIT SKK 92, and HIT 2000 were retrospectively reviewed to describe clinical features, treatment modalities, and outcome of children with primary CNS-PNETs of the spinal cord who were registered as observational patients. Out of 1,248 patients with medulloblastomas or CNS-PNETs registered in the HIT database four patients (female, n = 3) with primary CNS-PNETs of the spinal cord were identified. Age at diagnosis was 10, 16, 23, and 174 months. Location of primary tumors was medulla oblongata-T3, C2-T1, T10-L2, T7-T10. Two patients had metastatic disease at diagnosis. Complete and incomplete resection was performed in one patient each, whereas two patients underwent a biopsy only. Two patients received chemotherapy only, in accordance with the HIT 91 trial (sandwich chemotherapy arm). They developed disease progression and died six months after diagnosis. One patient was given chemotherapy in accordance with the HIT 2000 trial followed by craniospinal radiotherapy and four courses of maintenance chemotherapy. The patient is in complete remission almost four years after diagnosis. The fourth patient developed disease progression while receiving induction chemotherapy. Hence, chemotherapy was switched to a modified Head Start protocol. After three cycles he underwent double autologous stem cell transplantation and craniospinal irradiation. Forty months after diagnosis the patient is alive and well, but surveillance MRIs still show nodular enhancing lesions in the area of the primary tumor and intracranial meningeal enhancement. Primary CNS-PNETs of the spinal cord probably require multimodal treatment including radiotherapy to achieve sustained tumor control.
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Affiliation(s)
- Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria.
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40
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dos Santos Rubio EJ, Harhangi BS, Kros JM, Vincent AJPE, Dirven CMF. A Primary Extraosseous Ewing Sarcoma in the Cerebellopontine Angle of a Child: Review of Relevant Literature and Case Report. Neurosurgery 2010; 67:E1852-6. [DOI: 10.1227/neu.0b013e3181f82569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
We report the occurrence of a primary intracranial extraosseous Ewing sarcoma/peripheral primitive neuroectodermal tumor (EES/pPNET) in the cerebellopontine angle in a child.
CLINICAL PRESENTATION:
A 10-year-old girl presented with symptoms and signs of an infratentorial space-occupying lesion that was confirmed by magnetic resonance imaging and followed up by subtotal surgical resection. Tumor cells displayed membranous expression of CD99, and one of the typical translocations of EES/pPNET (chromosome 22) was demonstrated by cytogenetic analysis.
CONCLUSION:
The literature regarding the histopathological, molecular, radiological, prognostic, and therapeutic features of intracranial EES/pPNET is reviewed, emphasizing the distinction of this entity from the central PNET. Although exceptionally rare, intracranial EES/pPNET should be considered in the differential diagnosis of lesions in the cerebellopontine angle.
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Affiliation(s)
| | - B S Harhangi
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J M Kros
- Department of Neuropathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A J P E Vincent
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - C M F Dirven
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
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41
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Duan XH, Ban XH, Liu B, Zhong XM, Guo RM, Zhang F, Liang BL, Shen J. Intraspinal primitive neuroectodermal tumor: imaging findings in six cases. Eur J Radiol 2010; 80:426-31. [PMID: 20591597 DOI: 10.1016/j.ejrad.2010.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/30/2010] [Accepted: 06/02/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To retrospectively review CT and MRI findings in a series of six intraspinal primitive neuroectoderal tumors and to find out their radiological features. METHODS CT and MRI of six patients with surgically and pathologically proved intraspinal primitive neuroectoderal tumor were retrospectively reviewed. The tumor location, morphological features, signal intensity, calcification, contrast enhancement characteristics, involvement of paraspinal soft tissues and adjacent bony structures were assessed. RESULTS Of six patients, four had extradural lesions and two had intradural, extramedullary lesions. Most lesions were well defined and manifested heterogeneous iso- or hypo-intense signal on T1-weighted imaging and hyper-intense signal on T2-weighted imaging and moderate attenuation on CT, and were heterogeneously enhanced after contrast enhancement. The lesion extending through the intervertebral foramen with a large paraspinal soft tissue mass formed was found in four patients and vertebral bone involvement was seen in four patients. CONCLUSIONS Although imaging findings are not specific of intraspinal primitive neuroectoderal tumor, this diagnosis could be suggested when MR imaging depicts an intradural, extramedullary or extradural large well-circumscribed mass which extends out from intervertebral foramen and invades paraspinal soft tissues or vertebral bones in a young patient.
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Affiliation(s)
- Xiao-Hui Duan
- Department of Radiology, The Second Affiliated Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
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42
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Kiatsoontorn K, Takami T, Ichinose T, Chokyu I, Tsuyuguchi N, Ohsawa M, Ohata K. Primary epidural peripheral primitive neuroectodermal tumor of the thoracic spine. Neurol Med Chir (Tokyo) 2010; 49:542-5. [PMID: 19940407 DOI: 10.2176/nmc.49.542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 25-year-old male patient presented with an extremely rare primary spinal peripheral primitive neuroectodermal tumor (pPNET) manifesting as acutely progressive paraparesis and back pain. Neuroimaging and intraoperative examination showed that the tumor was confined to the epidural space of the thoracic spine. The patient was treated successfully by gross total resection of the tumor followed by chemotherapy and local radiotherapy. The present case illustrates the unexpected occurrence and important differential diagnosis of primary epidural pPNET of the thoracic spine in young patients presenting with progressive paraparesis and back pain.
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43
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Pytel P, Lukas RV. Update on diagnostic practice: tumors of the nervous system. Arch Pathol Lab Med 2009; 133:1062-77. [PMID: 19642733 DOI: 10.5858/133.7.1062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Changes in the practice of diagnosing brain tumors are formally reflected in the evolution of the World Health Organization classification. Beyond this classification, the practice of diagnostic pathology is also changing with the availability of new tests and the introduction of new treatment options. OBJECTIVE Glioblastomas, oligodendrogliomas, glioneuronal tumors, and primitive pediatric tumors are discussed in an exemplary way to illustrate these changes. DATA SOURCES Review of relevant publications through Medline database searches. CONCLUSIONS The example of glioblastomas shows how new predictive markers may help identify subgroups of tumors that respond to certain therapy regimens. The development of new treatment strategies also leads to different questions in the assessment of brain tumors, as seen in the example of pseudoprogression or the changes in tumor growth pattern in patients taking bevacizumab. Oligodendrogliomas illustrate how the identification of 1p/19q loss as a cytogenetic aberration aids our understanding of these tumors and changes diagnostic practice but also introduces new challenges in classification. Glioneuronal tumors are an evolving group of lesions. Besides a growing list of usually low-grade entities with well-defined morphologic features, these also include more poorly defined cases in which a component of infiltrating glioma is often associated with focal neuronal elements. The latter is biologically interesting but of uncertain clinical significance. Oligodendrogliomas and glioneuronal tumors both illustrate the importance of effective communication between the pathologist and the treating oncologist in the discussion of these patients. Finally, the discussion of primitive pediatric tumors stresses the clinical importance of the distinction between different entities, like atypical teratoid rhabdoid tumor, "central" (supratentorial) primitive neuroectodermal tumor, "peripheral" primitive neuroectodermal tumor, and medulloblastoma. In medulloblastomas, the recognition of different variants is emerging as a prognostic factor that may in the future also predict therapy responsiveness.
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Affiliation(s)
- Peter Pytel
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
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44
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Theeler BJ, Keylock J, Yoest S, Forouhar M. Ewing's sarcoma family tumors mimicking primary central nervous system neoplasms. J Neurol Sci 2009; 284:186-9. [PMID: 19394051 DOI: 10.1016/j.jns.2009.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 03/17/2009] [Accepted: 03/20/2009] [Indexed: 11/28/2022]
Abstract
Ewing's sarcoma family tumors (ESFTs) and embyronal tumors of the central nervous system are malignant primitive neuroectodermal tumors (PNETs) that can arise in the central nervous system, bones, or soft tissues. When ESFTs involve the central nervous system or nearby structures the diagnosis depends on cytogenetics and immunohistochemistry as these tumors can appear otherwise histologically identical to central PNETs. Correct diagnosis is essential as the treatment paradigms for both entities differ. We present two cases of isolated central nervous system presentations of ESFTs mimicking primary central nervous system neoplasms.
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Affiliation(s)
- Brett J Theeler
- United States Army, Department of Medicine/Neurology Service, United States.
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45
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Hrabálek L, Kalita O, Svebisova H, Ehrmann J, Hajduch M, Trojanec R, Kala M. Dumbbell-shaped peripheral primitive neuroectodermal tumor of the spine--case report and review of the literature. J Neurooncol 2008; 92:211-7. [PMID: 19050994 DOI: 10.1007/s11060-008-9744-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare. Here, we present a case study of a 29-year-old male with a dumbbell-shaped pPNET at the T9-10 spine level, including details of his examination, surgical procedures applied, histological and genetic findings, and his subsequent treatment. We discuss the clinical course, the pathology and treatment for this disease, the surgical approach to thoracic dumbbell tumors and we review the literature. To our knowledge, this is the first report of a case of a dumbbell-shaped intradural and spinal peripheral PNET.
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46
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Samaras V, Samaras E, Stergiou I, Konstantopoulou P, Arnaoutoglou C, Arnaoutoglou M, Varsos V, Barbatis C. Simultaneous occurrence of cerebellar medulloblastoma and pituitary adenoma: A case report. CASES JOURNAL 2008; 1:175. [PMID: 18811959 PMCID: PMC2556997 DOI: 10.1186/1757-1626-1-175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/23/2008] [Indexed: 12/18/2022]
Abstract
Purpose We present the unusual occurrence of two distinct neoplasms in a 42-year-old woman with an operated pituitary adenoma 18 years ago. Methods Clinical history, magnetic resonance imaging studies and histopathological findings were utilized for our diagnostic considerations. Results Concomitant presence of a cerebellar medulloblastoma secondary disseminated within the spinal canal and a pituitary macroadenoma, was identified. Conclusion To the best of our knowledge, this is the first reported case in which these two neoplasms are simultaneously occurred in the same individual. A short review of the literature is performed.
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Affiliation(s)
- Vassilis Samaras
- Department of Pathology, Hellenic Red Cross Hospital, Athens, Greece.
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47
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Ozdemir N, Usta G, Minoglu M, Erbay AM, Bezircioglu H, Tunakan M. Primary primitive neuroectodermal tumor of the lumbar extradural space. J Neurosurg Pediatr 2008; 2:215-21. [PMID: 18759606 DOI: 10.3171/ped/2008/2/9/215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) of the extradural space are very rare; only 10 cases have been reported in the English language literature. The histopathological diagnosis of primary spinal PNETs has been discussed for many years. These tumors have a rapidly progressive course, and there is no current consensus on the optimal therapeutic approach for these patients. The authors present a case of primary PNET located in the lumbar extradural space in a 13-year-old girl and report the clinical, radiological, histopathological, and surgical findings. They compare their findings with those from the other 10 cases reported in the literature and review relevant literature.
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Affiliation(s)
- Nail Ozdemir
- Department of Neurosurgery, Izmir Ataturk Training and Research Hospital, Narlidere-Izmir, Turkey.
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48
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Nutman A, Postovsky S, Zaidman I, Elhasid R, Vlodavsky E, Kreiss Y, Ben Arush MW. Primary intraspinal primitive neuroectodermal tumor treated with autologous stem cell transplantation: case report and review of the literature. Pediatr Hematol Oncol 2007; 24:53-61. [PMID: 17130114 DOI: 10.1080/08880010601001396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The authors describe the case of a 19-year-old female patient with a primary primitive neuroectodermal tumor (PNET) of the thoraco-lumbar spinal cord, who presented with acute urinary retention and back pain for 2 months. Magnetic resonance imaging revealed an intradural extramedullary tumor, 6.5 cm long, in the region of the conus medullaris. Histological examination disclosed a small round cell tumor with immunohistochemical characteristics of a peripheral PNET. Metastatic workup showed no evidence of an intracranial tumor or metastases outside the neuroaxis. The patient received multidisciplinary treatment, including surgical excision, irradiation of the entire cranio-spinal axis, and high-dose chemotherapy with autologous stem cell rescue. Presently, 24 months after diagnosis, the patient remains in complete remission.
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Affiliation(s)
- Amir Nutman
- Israel Defense Forces, Medical Corps, Haifa, Israel
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