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Akazawa M, Saito T, Ariyoshi K, Okadome M, Yokoyama R, Taguchi K. Adjuvant chemotherapy for a primitive neuroectodermal tumor of the uterine corpus: A case report and literature review. J Obstet Gynaecol Res 2018; 44:2008-2015. [PMID: 30051552 DOI: 10.1111/jog.13753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/17/2018] [Indexed: 12/16/2022]
Abstract
A primitive neuroectodermal tumor (PENT) belongs to the category of a Ewing sarcoma. A PENT of the uterus is rare and has been known to be very aggressive by nature. Owing to the rarity of the tumor, there is no optimal treatment at present. In many cases, after hysterectomy, chemotherapy or radiation therapy has been performed. However, an effective chemotherapy regimen was unclear. In the soft tissue sarcoma area, the chemotherapy approach has recently greatly improved. Vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide (VDC-IE) therapy has improved the survival rate of patients with Ewing sarcoma/PENT. Thus, VDC-IE therapy may be used for a uterine PENT. Here, we report a case of a uterine PENT in a premenopausal woman successfully treated with multimodality treatment including VDC-IE therapy and discuss the optimal chemotherapy for a uterine PENT through a literature review.
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Affiliation(s)
| | - Toshiaki Saito
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kazuya Ariyoshi
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Masao Okadome
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Ryohei Yokoyama
- Orthopedic Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Kyushu Cancer Center, Fukuoka, Japan
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2
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Homma T, Nakao T, Maebayashi T, Ishige T, Hao H. Uterine corpus tumor with neuroectodermal differentiation and frequent ganglion-like cells in a postmenopausal woman. Gynecol Oncol Rep 2018; 24:65-77. [PMID: 29915801 PMCID: PMC6003429 DOI: 10.1016/j.gore.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 11/25/2022] Open
Abstract
Uterine neuroectodermal tumors (NETs) are uncommon malignant neoplasm with poor prognosis. Ganglion-like cells with fibrillary background as major component of uterine NETs are extremely rare. We present a patient affected by uterine NET with frequent ganglion-like cells, resembling ganglioneuroblastoma. This case report is important to define the pathogenesis and establish better treatments for neuroectodermal tumors.
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Affiliation(s)
- Taku Homma
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 1-30 Ohyaguchikamimachi, Itabashi, Tokyo 173-0032, Japan
| | - Takehiro Nakao
- Department of Gynecology, Nihon University School of Medicine, 1-30 Ohyaguchikamimachi, Itabashi, Tokyo 173-0032, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, 1-30 Ohyaguchikamimachi, Itabashi, Tokyo 173-0032, Japan
| | - Toshiyuki Ishige
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 1-30 Ohyaguchikamimachi, Itabashi, Tokyo 173-0032, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 1-30 Ohyaguchikamimachi, Itabashi, Tokyo 173-0032, Japan
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3
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Petković M, Zamolo G, Muhvić D, Coklo M, Stifter S, Antulov R. The First Report of Extraosseous Ewing's Sarcoma in the Rectovaginal Septum. TUMORI JOURNAL 2018; 88:345-6. [PMID: 12400989 DOI: 10.1177/030089160208800419] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background To report an extremely rare case of Ewing's sarcoma located in the rectovaginal septum. Ewing's sarcoma is a highly malignant neoplasm of bone, which usually occurs during childhood. Common extraosseous localizations of Ewing's sarcoma include the trunk, extremities, uterus, cervix and vagina. Methods A 45-year-old woman presented to us with a six-month history of pain in the lower abdomen during intercourse. Pelvic examination was performed and a palpable mass was found. The mass had a size of 9 × 6 cm, a soft tissue consistency, was partially movable and the patient felt the pain during palpation. Examination of the inguinal lymph nodes revealed no signs of inguinal adenopathy. The results of laboratory tests, rectoscopy, chest X-rays, barium enema and bone scan were normal. Computed tomography (CT) showed an inhomogeneous expansive mass in the rectovaginal septum measuring 8.7 × 6.1 cm, without any signs of rectum or bladder invasion. The vascular structures of the pelvis were normal. At laparotomy the process was judged inoperable and only biopsy of the tumor mass was carried out. Histology showed a neoplasm with small, round to oval cells with scarce cytoplasm. Immunohistology with the monoclonal antibody CD99 (MIC-2 gene product, Ewing's sarcoma marker, clone 12E7, DAKO A/S, Glostrup, Denmark) revealed an extraosseous Ewing's sarcoma. The patient was treated with chemotherapy followed by whole-pelvis external beam radiation and intracavitary brachytherapy. Results A residual mass measuring 3.5 × 2.5 cm was visible on a control CT scan 18 months after treatment; however, the patient was feeling well and refused surgery to remove the residual mass. Conclusions To our knowledge this is the first reported case of extraosseous Ewing's sarcoma in the rectovaginal septum.
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Affiliation(s)
- Marija Petković
- Department of Oncology and Radiotherapy, Clinical Hospital Center, Rijeka, Croatia
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4
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De Nola R, Di Naro E, Schonauer LM, Lucarelli G, Battaglia M, Fiore MG, Mastrolia SA, Loverro G. Clinical management of a unique case of PNET of the uterus during pregnancy, and review of the literature. Medicine (Baltimore) 2018; 97:e9505. [PMID: 29480840 PMCID: PMC5943895 DOI: 10.1097/md.0000000000009505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origin. They usually involve bone and soft tissues, and have a higher incidence in childhood. PATIENT CONCERNS In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. DIAGNOSES During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. INTERVENTION During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. OUTCOME Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health.Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. LESSONS PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled.
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Affiliation(s)
- Rosalba De Nola
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Luca Maria Schonauer
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | | | | | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
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5
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Primitive Neuroectodermal Tumors of the Female Genital Tract: A Morphologic, Immunohistochemical, and Molecular Study of 19 Cases. Am J Surg Pathol 2017; 41:761-772. [PMID: 28296680 DOI: 10.1097/pas.0000000000000831] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary primitive neuroectodermal tumor (PNET) of the female genital tract is rare, and its proper classification remains unclear. The clinical, histologic, and immunophenotypic features as well as EWSR1 rearrangement status of 19 gynecologic PNETs, including 10 ovarian, 8 uterine, and 1 vulvar tumors, are herein reported. Patient age ranged from 12 to 68 years, with a median age of 20 and 51 years among those with ovarian and uterine PNETs, respectively. Morphologic features of central nervous system (CNS) tumors were seen in 15 PNETs, including 9 medulloblastomas, 3 ependymomas, 2 medulloepitheliomas, and 1 glioblastoma, consistent with central PNET. The remaining 4 PNETs were composed entirely of undifferentiated small round blue cells and were classified as Ewing sarcoma/peripheral PNET. Eight PNETs were associated with another tumor type, including 5 ovarian mature cystic teratomas, 2 endometrial low-grade endometrioid carcinomas, and a uterine carcinosarcoma. By immunohistochemistry, 17 PNETs expressed at least 1 marker of neuronal differentiation, including synaptophysin, NSE, CD56, S100, and chromogranin in 10, 8, 14, 8, and 1 tumors, respectively. GFAP was positive in 4 PNETs, all of which were of central type. Membranous CD99 and nuclear Fli-1 staining was seen in 10 and 16 tumors, respectively, and concurrent expression of both markers was seen in both central and Ewing sarcoma/peripheral PNETs. All tumors expressed vimentin, whereas keratin cocktail (CAM5.2, AE1/AE3) staining was only focally present in 4 PNETs. Fluorescence in situ hybridization was successful in all cases and confirmed EWSR1 rearrangement in 2 of 4 tumors demonstrating morphologic features of Ewing sarcoma/peripheral PNET and concurrent CD99 and Fli-1 expression. In conclusion, central and Ewing sarcoma/peripheral PNETs may be encountered in the female genital tract with central PNETs being more common. Central PNETs show a spectrum of morphologic features that overlaps with CNS tumors but lack EWSR1 rearrangements. GFAP expression supports a morphologic impression of central PNET and is absent in Ewing sarcoma/peripheral PNET. Ewing sarcoma/peripheral PNETs lack morphologic features of CNS tumors.
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Yöriükoğlu K, Aktaş S, Göre O, Özen E. Malignant Mixed Mullerian Tumor of the Uterus with Prominent Neuroectodermal Differentiation. Int J Surg Pathol 2016. [DOI: 10.1177/106689699800600304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of malignant mixed Müllerian tumor of the uterus with prominent neuroectodermal differentiation is reported. The most notable feature of the tumor was its large component of primitive neuroepithelium lining tubules. The islands of neuroectodermal tissue were admixed with conventional endometrioid adenocarcinoma and sarcomatous elements resembling malignant fibrous histiocytoma only in a small focus.
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Affiliation(s)
- Kutsal Yöriükoğlu
- Dokuz Eylül University, School of Medicine, Department of Pathology, İzmir, Turkey; Dokuz Eylül Üniversitesi, Tip Fakülltesi, Patoloji ABD, 35340 İnciralti, İzmir, Turkey
| | | | | | - Emek Özen
- Dokuz Eylül University, School of Medicine, Department of Pathology, İzmir, Turkey
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Abstract
A primary pigmented neuroectodermal tumor of the uterine cervix is described. The patient was 57 years old when she presented with vaginal bleeding. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph adenectomy, followed by chemotherapy. Histologically, the tumor was characterized by the concomitant presence of two neural crest derivatives, neuroblasts and melano cytes. The latter cells were arranged in a tubulopapillary fashion and contained abun dant melanin. Histochemical, immunohistochemical, and electron microscopic exami nation confirmed the diagnosis. The patient was alive without evidence of disease 5 years later. An origin of this tumor from abnormally migrated neural crest cells is suggested. Int J Surg Pathol 2(1):31-36, 1994
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Affiliation(s)
| | - M.L. Carcangiu
- Pathology, Yale University School of Medicine, New Haven, Con necticut
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8
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Shimada C, Todo Y, Okamoto K, Akashi D, Yamashiro K, Hasegawa T. Central type primitive neuroectodermal tumor/neuroblastoma of the uterus: A case report. J Obstet Gynaecol Res 2014; 40:2118-22. [DOI: 10.1111/jog.12459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/26/2014] [Indexed: 01/11/2023]
Affiliation(s)
- Chisa Shimada
- Department of Obstetrics and Gynaecology; Hokkaido University School of Medicine; Sapporo Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology; National Hospital Organization, Hokkaido Cancer Center; Sapporo Japan
| | - Kazuhira Okamoto
- Division of Gynecologic Oncology; National Hospital Organization, Hokkaido Cancer Center; Sapporo Japan
| | - Daisuke Akashi
- Division of Gynecologic Oncology; National Hospital Organization, Hokkaido Cancer Center; Sapporo Japan
| | - Katsushige Yamashiro
- Division of Pathology; National Hospital Organization, Hokkaido Cancer Center; Sapporo Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology; Sapporo Medical University School of Medicine; Sapporo Japan
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Abstract
Ewing sarcoma, a highly malignant neoplasm of the bone, usually occurs during childhood. About 15% are extraosseous. The Ewing family of tumors (EFTs) are extremely rare in the vagina. A 40-year literature review from 1970 to 2010 revealed only nine cases. A 32-year-old woman presented with a painless vaginal mass. A wide excision was performed. Histopathology, immunohistochemistry and molecular studies confirmed extraosseous vaginal Ewing sarcoma. Despite aggressive chemotherapy with a good initial response, she developed local recurrence and metastasis to the spine and pelvis and succumbed 22 months later. A previous infiltrating ductal breast cancer, treated and in remission complicated the picture. We present the tenth case of vaginal Ewing sarcoma and the fourth to be confirmed by molecular studies. We stress the importance of molecular techniques in definitely diagnosing EFTs, especially those arising at unusual sites, particularly in the context of a previous diagnosis of breast cancer.
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Affiliation(s)
- Lovina Machado
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman.
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10
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Dutta S, Dasgupta C, Choudhury K. Paravaginal peripheral primitive neuroectodermal tumor: A rare tumor. Indian J Med Paediatr Oncol 2012; 32:171-3. [PMID: 22557788 PMCID: PMC3342728 DOI: 10.4103/0971-5851.92823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Peripheral primitive neuroectodermal tumor (PNET) of the female genital tract, particularly those in the vaginal and paravaginal region, are extremely rare. A 36-year-old woman presented with clinical features similar to that of a case of cervical fibroid. It was only after surgery that the histopathology suggested it to be a malignant round cell tumour and was CD99 positive. She underwent adjuvant chemotherapy with the Ifosfamide and Etoposide alternating with Vincristine, Doxorubicin, and Cyclophosphamide regime and radical radiotherapy. She is disease free at 12 months of follow-up. The importance of immunostaining and adequate histopathology report lies in the fact that the correct diagnosis thus achieved enabled us to manage a rare case of paravaginal PNET with a multimodality approach.
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Affiliation(s)
- Samrat Dutta
- Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
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11
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Weissferdt A, Moran CA. Primary pulmonary primitive neuroectodermal tumor (PNET): a clinicopathological and immunohistochemical study of six cases. Lung 2012; 190:677-83. [PMID: 22802134 DOI: 10.1007/s00408-012-9405-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND The clinicopathological and immunohistochemical features of six primary pulmonary primitive neuroectodermal tumors (PNETs) are reported. METHODS The patients were four men and two women aged 22-56 years (mean = 32.3 years). The main presenting symptoms included chest pain, shortness of breath, and cough. The tumor size ranged from 4 to 9.6 cm. RESULTS Macroscopically, the tumors were circumscribed, yellow-white in color, and of soft and friable consistency. Histologically, the lesions were composed of a monomorphic population of solidly packed round cells with a round-to-ovoid nucleus, fine chromatin, small nucleoli, and scanty pale cytoplasm. Immunohistochemically, the tumor cells were uniformly positive for CD99, neuron-specific enolase, and vimentin, and single cases focally expressed cytokeratin and S100. Fluorescence in situ hybridization analysis performed in two cases showed positive rearrangement for the EWSR1 gene at the 22q12 locus. Follow-up information available for four patients showed that three had died 24-54 months after diagnosis and one patient is alive 11 months after diagnosis. Two patients were lost to follow-up. CONCLUSION Primary PNETs of the lung are rare tumors that need to be added to the differential diagnosis of primary pulmonary neoplasms composed of small cells. Awareness of this entity as a primary pulmonary neoplasm is required in order to avoid misdiagnosis and unsuitable treatment of patients.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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12
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Donner LR. Uterine neuroectodermal tumor with ependymoblastic features in an infant with clonal +del (2)(q11.2),-13: a possible role of increased gene dosage on 2pter-2q11.2 in the tumorigenesis. Pediatr Dev Pathol 2012; 15:226-31. [PMID: 21815817 DOI: 10.2350/10-12-0948-cr.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clonal +(2)(q11.2),-13 was detected in a uterine neuroectodermal tumor with ependymoblastic features arising in an infant. The tumor expressed vimentin, nestin, CD56, CD99, microtubule-associated protein 1B (MAP 1B), focally microtubule-associated protein 2 (MAP 2), synaptophysin, neuron-specific enolase, and, very focally, epithelial membrane antigen. Because trisomy 2 was previously detected in a medulloepithelioma of pelvic soft tissue and in several neuroectodermal tumors of the central nervous system, this finding is indicative of a possible role of increased dosage of gene(s) on chromosome 2 in the tumorigenesis of these neoplasms and of their histogenetic relatedness.
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Affiliation(s)
- Ludvik R Donner
- Department of Pathology, Texas A&M Health Science Center, Temple, TX, USA.
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13
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Abstract
High-grade endometrial carcinomas are a heterogeneous group of clinically aggressive tumors. They include FIGO grade 3 endometrioid carcinoma, serous carcinoma, clear cell carcinoma, undifferentiated carcinoma, and malignant mixed Müllerian tumor (MMMT). Epidemiologic, genetic, biologic prognostic and morphologic differences between these entities are striking in prototypic cases, yet substantial overlap exists and diagnostic criteria and therapeutic approaches that account for the group's diversity are currently insufficient. FIGO grade 3 endometrioid carcinoma demonstrates solid, trabecular or nested growth and may resemble poorly differentiated squamous cell carcinoma. Endometrioid glandular differentiation is usually focally present. Serous carcinoma usually displays papillary architecture but glandular and solid patterns may predominate. Tumor cells typically display diffuse and severe atypia. Clear cell carcinoma should be diagnosed by recognizing characteristic papillary or tubulocystic architecture with cuboidal tumor cells showing atypical but uniform nuclei. Cells with clear cytoplasm are frequently but not always present. On the other hand, clear cells may be encountered in endometrioid and serous carcinomas. Immunohistochemical stains for p53, p16, ER, PR, mib-1, hepatocyte nuclear factor 1β and pan-cytokeratin can be helpful in classifying these high-grade carcinomas. They should be used in concert with thorough morphologic examination, as part of a rational panel of markers and only in specific circumstances. Although these tumors may appear clinically and even morphologically similar, demographic and epidemiologic features as well as patterns of spread and treatment modalities differ.
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Affiliation(s)
- Esther Oliva
- Pathology Department, Massachusetts General Hospital, 55 Fruit Street WRN 2, Boston, MA 02114-2696, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Heterologous and rare homologous sarcomas of the uterine corpus: a clinicopathologic review. Adv Anat Pathol 2011; 18:60-74. [PMID: 21169739 DOI: 10.1097/pap.0b013e3182026be7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pure sarcomas of the uterine corpus are uncommon, constituting less than 3% of all malignancies at this site, and most of them are leiomyosarcomas and endometrial stromal sarcomas. Rare histotypes of homologous sarcomas and heterologous sarcomas are occasionally encountered, and the absence of significant accumulated experience with these histotypes at this location may potentially raise diagnostic and patient management difficulties. In this article, the clinicopathologic attributes of all earlier reported sarcomas of the uterine corpus other than leiomyosarcomas and endometrial stromal sarcomas are summarized. Included are embryonal rhabdomyosarcoma, pleomorphic rhabdomyosarcoma, angiosarcoma, alveolar soft part sarcoma, malignant perivascular epithelioid cell tumors (PEComas), osteosarcoma, chondrosarcoma, liposarcomatous tumors, malignant extrarenal rhabdoid tumors, Ewing sarcoma/primitive neuroectodermal tumor, and other rare histotypes. Embryonal rhabdomyosarcoma (20%), Ewing sarcoma/primitive neuroectodermal tumor (17%), angiosarcoma (14%), and pleomorphic rhabdomyosarcoma (13%) appeared to be more common than the others, although there was no single overwhelmingly prevalent histotype in the group. A subset, including embryonal rhabdomyosarcoma, alveolar soft part sarcoma, and PEComas, peak in the premenopausal years, but most of the others were observed in postmenopausal women. Favorable outcomes have been reported for the patients diagnosed with alveolar soft part sarcoma, and the prognosis for their counterparts with PEComa remains a matter of debate. Multimodal therapeutic approaches to contemporary patients with embryonal rhabdomyosarcomas have resulted in significantly improved outcomes. Unfortunately, most of the other sarcomas have been associated with rapid tumor progression and unfavorable patient outcomes. The differential diagnosis for these sarcomas is often extensive and varies by histotype, but their accurate diagnosis fundamentally requires the careful exclusion of biphasic malignancies.
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16
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Ren YL, Tang XY, Li T. Ewing sarcoma-primitive neuroectodermal tumor of the uterus: a clinicopathologic, immunohistochemical and ultrastructural study of one case. Arch Gynecol Obstet 2010; 283:1139-43. [PMID: 20589387 DOI: 10.1007/s00404-010-1557-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 06/03/2010] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Ewing sarcoma-primitive neuroectodermal tumors (ES/PNET) constitute a family of neoplasms characterized by a continuum of neuroectodermal differentiation. ES/PNET of the uterus is rare. There are 43 cases published in the English literature as far as we know. We describe an additional case. CASE REPORT A 56-year-old woman presented with a 2-month history of irregular menopausal vaginal bleeding. After surgical excision, microscopic, immunohistochemical and electron microscopic examination suggested the diagnosis of ES/PNET. The patient underwent combined chemotherapy consisting of ifosfamide, etoposide, and cisplatin. She was alive with no evidence of recurrence or metastasis after 41 months of the initial operation. DISCUSSION In spite of the rarity of ES/PNET, we should consider it in the differential diagnosis of small cell neoplasms of the uterus.
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Affiliation(s)
- Ya-Li Ren
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing 100034, People's Republic of China.
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17
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Bhardwaj M, Batrani M, Chawla I, Malik R. Uterine primitive neuroectodermal tumor with adenosarcoma: a case report. J Med Case Rep 2010; 4:195. [PMID: 20584309 PMCID: PMC2913979 DOI: 10.1186/1752-1947-4-195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 06/28/2010] [Indexed: 01/17/2023] Open
Abstract
Introduction Primitive neuroectodermal tumor of the uterus is extremely rare. They occur as either pure primitive neuroectodermal tumors or admixed with neoplasms of mullerian origin. Case presentation A case of uterine primitive neuroectodermal tumor with adenosarcoma in a 50-year-old Asian Indian woman is presented. Histologically, the neoplasm displayed perivascular pseudorosettes and occasional Homer-Wright rosettes. A strong positivity for neuronspecific enolase and synaptophysin was noted, while chromogranin and CD99 were negative. Merging imperceptibly with the neuroectodermal components were the areas of adenosarcoma. Conclusion To the best of our knowledge, this report represents the second case of a uterine primitive neuroectodermal tumor with an admixed adenosarcoma.
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Affiliation(s)
- Minakshi Bhardwaj
- Department of Pathology, Dr, Ram Manohar Lohia Hospital, New Delhi, India.
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18
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Bartosch C, Vieira J, Teixeira MR, Lopes JM. Endometrial endometrioid adenocarcinoma associated with primitive neuroectodermal tumour of the uterus: a poor prognostic subtype of uterine tumours. Med Oncol 2010; 28:1488-94. [PMID: 20512430 DOI: 10.1007/s12032-010-9579-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 05/17/2010] [Indexed: 12/18/2022]
Abstract
Uterine primitive neuroectodermal tumours are extremely rare tumours. They can occur in pure form or combined with another component including endometrioid adenocarcinoma. We aimed to review the clinical impact of neuroectodermal phenotype in uterine tumours, after we recently diagnosed one such case. A 58-year-old female presented with irregular vaginal bleeding. Ultrasonography and CT showed the presence of a large uterine mass with irregular contours. At laparotomy it was found to extend to the right ureter, sigmoid colon and some small intestinal loops. Microscopic examination revealed that the tumour consisted of an endometrioid adenocarcinoma component merging with an extensive neuroectodermal component. No EWSR1 or FUS rearrangement was found in the two tumour components. The patient received two courses of chemotherapy but died 11 months after the initial diagnosis. We reviewed the morphological and molecular criteria for the diagnosis of uterine primitive neuroectodermal tumours published in the literature. We conclude that regardless of the detection of an EWSR1 rearrangement, the presence of a neuroectodermal differentiation component in these rare uterine tumours is a marker of aggressive behaviour, and its presence should be highlighted in the diagnosis.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Hospital de S. João, E.P.E., and Department of Pathology, Medical Faculty, University of Porto, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal.
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Rekhi B, Qureshi S, Basak R, Desai SB, Medhi S, Kurkure P, Menon S, Maheshwari A, Jambhekar NA. Primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old woman: a case report. J Med Case Rep 2010; 4:88. [PMID: 20233457 PMCID: PMC2848680 DOI: 10.1186/1752-1947-4-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 03/17/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Primary Ewing's sarcoma or primitive neuroectodermal tumor of the genital tract of women is uncommon. Rarer still is its occurrence in the vagina, with only five cases described so far. Out of these, only one case was confirmed using molecular analysis. Case presentation We present an extremely rare case of Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old Indian girl. She presented with a vaginal mass that was initially diagnosed as a malignant round cell tumor. Immunohistochemistry showed diffuse positivity for vimentin, membranous positivity for MIC2, and positivity for BCL2 and FLI-1. On the other hand, she was negative for cytokeratin, epithelial membrane antigen, desmin, Myo D-1, myogenin and smooth muscle actin. A diagnosis of primitive neuroectodermal tumor was thus offered. Furthermore, a molecular analysis of our patient using reverse transcription-polymerase chain reaction technique showed positivity for t(11; 22) (q24; q12) (EWSR1-FLI1), thus confirming the diagnosis of a Ewing's sarcoma/primitive neuroectodermal tumor. Our patient was offered chemotherapy on Institutional protocol EFT 2001. Conclusion This is a rare case of primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor, which was confirmed with molecular analysis, in the youngest patient known so far. This study reinforces the value of integrating morphological features with membranous MIC2 positivity, along with application of molecular techniques in objective identification of an Ewing's sarcoma or primitive neuroectodermal tumor at uncommon sites.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Dr EB Road, Parel, Mumbai, 400012, India.
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20
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Uterine Tumors with Neuroectodermal Differentiation. A Report of 4 Cases. Pathol Oncol Res 2010; 16:601-8. [DOI: 10.1007/s12253-010-9249-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 02/02/2010] [Indexed: 12/23/2022]
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21
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Miscellaneous Pseudotumors and Mesenchymal Tumors of the Female Genital Tract. Surg Pathol Clin 2009; 2:755-83. [PMID: 26838778 DOI: 10.1016/j.path.2009.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Benign and malignant soft tissue tumors and pseudotumors can rarely arise anywhere in the female genital tract. Their pathologic features as well as behavior typically overlap with those described in tumors involving typical locations. However, due to their rarity, not infrequently these tumors represent a diagnostic challenge. Their diagnosis should be based on careful gross examination, thorough sampling, and morphologic evaluation, applying a selected immunohistochemical panel and molecular studies. Accurate classification of these tumors is important because their clinical behavior, prognosis, and therapy differ markedly. This article outlines several mesenchymal lesions reported in the female genital tract, encompassing recent histologic, immunohistochemical, and molecular findings, with special emphasis on problems in the differential diagnosis.
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22
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Retroperitoneal primitive neuroectodermal tumour (PNET). A case report and review of the literature. Rep Pract Oncol Radiother 2009. [DOI: 10.1016/j.rpor.2009.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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23
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Primary vulvar Ewing's sarcoma/primitive neuroectodermal tumor in a post-menopausal woman: a case report. Pathol Res Pract 2009; 206:476-9. [PMID: 19656640 DOI: 10.1016/j.prp.2009.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 05/04/2009] [Accepted: 07/13/2009] [Indexed: 12/14/2022]
Abstract
Ewing's sarcomas/peripheral primitive neuroectodermal tumors (ES/pPNETs) are high-grade malignant neoplasms rarely found outside the skeletal system. Only 12 cases of vulvar ES/pPNET have so far been reported, all involving children or women of child-bearing age. We describe the case of a 52-year-old woman who was admitted to our hospital for the local excision of a 4cm vulvar mass, originally thought to be a Bartholin's gland cyst. It was subsequently found to consist of small round cells positive for anti-CD99 antibody, thus suggesting a diagnosis of ES/pPNET. The demonstration of EWSR1 gene translocations by means of fluorescent in situ hybridization excluded small-cell carcinoma, squamous cell carcinoma of the small type, Merkel cell carcinoma, and lymphoblastic lymphoma. After surgery, the patient received six cycles of polychemotherapy and radiotherapy; she is still alive and well after 1 year of follow-up. Our findings underline the crucial role of molecular biology techniques in the differential diagnosis of small round cell tumors in these unusual locations.
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24
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Nwofor AME, Ikechebelu JI. Uterovesical fistula and bladder stones following bladder penetration by a perforating intrauterine contraceptive device. J OBSTET GYNAECOL 2009; 23:683-4. [PMID: 14617489 DOI: 10.1080/01443610310001609560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A M E Nwofor
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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25
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Quddus MR, Rashid L, Sung CJ, Steinhoff MM, Cunxian Zhang, Lawrence WD. Ewing's Sarcoma / Peripheral Primitive Neuroectodermal Tumor (ES/PNET) Differentiation in Endometrial Serous Carcinomas. Reprod Sci 2009; 16:591-5. [DOI: 10.1177/1933719109332824] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Ruhul Quddus
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island,
| | - Lanita Rashid
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - C. James Sung
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Margaret M. Steinhoff
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cunxian Zhang
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - W. Dwayne Lawrence
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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26
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Carboplatin and paclitaxel adjuvant chemotherapy in primitive neuroectodermal tumor of the uterine corpus. Am J Obstet Gynecol 2009; 200:e6-9. [PMID: 19110219 DOI: 10.1016/j.ajog.2008.08.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/18/2008] [Accepted: 08/30/2008] [Indexed: 12/30/2022]
Abstract
Primitive neuroectodermal tumor of the uterine corpus (PNET) is rare and appears to have an aggressive clinical course. We report on a postmenopausal woman with optimal surgically cytoreduced advanced-stage PNET in which adjuvant combination chemotherapy with platinum and taxane agents was unsuccessful in extending her disease-free survival.
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27
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Extraskeletal neuroectodermal tumour of the vagina: a single case report and review. Arch Gynecol Obstet 2009; 280:465-8. [PMID: 19148662 DOI: 10.1007/s00404-008-0898-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 12/09/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED A case report and review of an extraskeletal neuroectodermal tumour of the vagina. BACKGROUND Ewing's sarcoma (ES) and primitive neuroectodermal tumours (PNETs) account for approximately 6-10% of primary malignant bone tumours and, following osteosarcoma, are the second most common group of bone sarcomas in children. Ewing's sarcoma rarely affects the genitourinary tract. We report a rare case of extraskeletal Ewing's sarcoma diagnosed in a 47-year-old Indian woman presenting with a simple cystic lesion in the posterior wall of the vagina. The histopathology revealed a rare presentation of a primitive malignant extraskeletal neuroectodermal tumour. CONCLUSION As our PubMed review found only six previously reported cases of vaginal extraskeletal Ewing's sarcoma. Presentation as vaginal masses helped in early disease detection.
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28
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Uterine tumors with neuroectodermal differentiation: a series of 17 cases and review of the literature. Am J Surg Pathol 2008; 32:219-28. [PMID: 18223324 DOI: 10.1097/pas.0b013e318093e421] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Uterine tumors with neuroectodermal differentiation, frequently referred to as primitive neuroectodermal tumors (PNETs), are uncommon. The clinicopathologic features of 17 such cases reviewed at the M.D. Anderson Cancer Center (MDACC) are presented along with a review of the literature. All of the pathology material was reviewed at MDACC, and in all cases, immunohistochemistry contributed to the diagnosis. In 12 cases, in situ hybridization techniques were used to determine whether a rearrangement of the EWSR1 gene, required for a diagnosis of peripheral PNET, was present. Clinical information was obtained from a patient chart review. Ages ranged from 31 to 81 years (median 58). Clinical presentations included vaginal bleeding (9), back pain (1), presumed fibroids (2), pelvic mass (1), incidental finding at hysterectomy (1), and unknown (3). Twelve patients had surgery or imaging to determine stage: I (2), II (0), III (6), and IV (4). Five patients had biopsy only. Ten tumors had only neuroectodermal components. In 7 tumors, the neuroectodermal component was admixed with an additional component including unclassified sarcoma (2 cases), rhabdomyosarcoma, endometrioid carcinoma, adenosarcoma and malignant mixed Mullerian tumor (2 cases). Follow-up, available for 13 patients, ranged from 2 to 41 months with 7 patients dead of disease 2 to 26 months after diagnosis. Six patients are alive with no evidence of disease after follow-up ranging from 6 to 41 months. Four patients were lost to follow-up. Results for the most commonly used immunohistochemistry studies include cytokeratin, 13/15 tumors negative (2 focally positive); synaptophysin, 15/16 tumors positive; neurofilament, 10/11 tumors positive; and CD99, 7/9 tumors positive (2 tumors had nonspecific cytoplasmic staining). None of the 12 tumors tested had a detectable rearrangement in the EWSR1 gene. Uterine tumors with neuroectodermal differentiation, similar to more common endometrial malignancies, tend to occur in postmenopausal women and frequently present with vaginal bleeding. An immunohistochemistry panel including cytokeratin, neurofilament, synaptophysin, and CD99 can highlight neuroectodermal differentiation and identify tumors for which molecular testing should be considered. Tumors without a rearrangement of the EWSR1 gene should be descriptively characterized as uterine tumors with neuroectodermal differentiation or alternatively central type PNETs rather than PNET, not otherwise specified to avoid confusion with peripheral PNET.
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29
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McCluggage WG, Sumathi VP, Nucci MR, Hirsch M, Dal Cin P, Wells M, Flanagan AM, Fisher C. Ewing family of tumours involving the vulva and vagina: report of a series of four cases. J Clin Pathol 2007; 60:674-80. [PMID: 17557870 PMCID: PMC1955083 DOI: 10.1136/jcp.2006.040931] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ewing's sarcoma and peripheral primitive neuroectodermal tumour (pPNET) are now regarded as two morphological ends of a spectrum of neoplasms, characterised by a t(11;22) or other related chromosomal translocation involving the EWS gene on chromosome 22 and referred to as Ewing family of tumours (EFTs). EFTs are extremely rare in the vulva and vagina, a review of the literature revealing only 13 previously reported possible cases, most of which have not had molecular confirmation. In this study, four new cases of EFTs involving the vulva (three cases) or vagina (one case) are reported. RESULTS The tumours occurred in women aged 19, 20, 30 and 40 years and ranged in size from 3 to 8 cm. Morphologically, all neoplasms had a lobulated architecture and were composed of solid aggregates of cells. In one case, occasional rosettes were formed. In all the tumours, there was diffuse membranous staining with CD99; nuclear positivity with FLI-1 was present in two cases. Three cases were focally positive with the broad-spectrum cytokeratin AE1/3, all were diffusely positive with vimentin and all were desmin negative. In two cases, a t(11;22) (q24;q12) (EWSR1-FLI-1) chromosomal translocation was demonstrated by reverse transcriptase-PCR (one case) and fluorescence in situ hybridisation (FISH) (one case), and in another case a rearrangement of the EWSR1 gene on chromosome 22 was demonstrated by FISH. In the other case, a variety of molecular studies did not reveal a translocation involving the EWS gene but this tumour, on the balance of probability, is still considered to represent a neoplasm in the EFTs. Follow-up in two cases revealed that one patient developed pulmonary metastasis and died and another is alive without disease at 12 months. CONCLUSIONS This report expands the published literature regarding EFTs involving the vulva and vagina and stresses the importance of molecular techniques in firmly establishing the diagnosis, especially when these neoplasms arise at unusual sites.
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MESH Headings
- 12E7 Antigen
- Adolescent
- Adult
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Cell Adhesion Molecules/metabolism
- Child
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 22/genetics
- Female
- Humans
- Immunoenzyme Techniques
- Microfilament Proteins/metabolism
- Middle Aged
- Neoplasm Proteins/metabolism
- Receptors, Cytoplasmic and Nuclear/metabolism
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/pathology
- Trans-Activators
- Translocation, Genetic
- Vaginal Neoplasms/genetics
- Vaginal Neoplasms/metabolism
- Vaginal Neoplasms/pathology
- Vulvar Neoplasms/genetics
- Vulvar Neoplasms/metabolism
- Vulvar Neoplasms/pathology
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland.
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30
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Park JY, Lee S, Kang HJ, Kim HS, Park SY. Primary Ewing's sarcoma-primitive neuroectodermal tumor of the uterus: a case report and literature review. Gynecol Oncol 2007; 106:427-32. [PMID: 17572479 DOI: 10.1016/j.ygyno.2007.04.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 04/06/2007] [Accepted: 04/06/2007] [Indexed: 12/28/2022]
Abstract
BACKGROUND Primary Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) of the uterus is an extremely rare malignancy. CASE A 30-year-old Korean woman presented with abnormal uterine bleeding with uterine enlargement. A computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen and pelvis showed a huge uterine mass measuring 18 x 20 x 21 cm, metastasis to both pelvic and para-aortic lymph nodes, and omental infiltration. The pathology report of the uterine mass described a uniformly hypercellular tumor, which was arranged in diffuse solid sheets of uniform, small, rounded, and sometimes spindle-shaped cells, with scanty cytoplasm. Immunohistochemically, the mass tested positive for vimentin, CD99, and chromogranin. The patient received several courses of combination chemotherapy and radiotherapy but died from tumor progression 16 months after the initial diagnosis. CONCLUSION(S) This is a rare case of primary uterine ES-PNET in a woman of reproductive age. A review of the literature indicates that primary uterine ES-PNET requires early diagnosis and multimodality treatment including surgery, chemotherapy, and radiotherapy. The behavior of this tumor is potentially aggressive.
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Affiliation(s)
- Jeong-Yeol Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 411-351, Korea
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31
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Mittal S, Sumana G, Gupta M, Gupta B. Primitive neuroectodermal tumor of the uterus: a case report. Int J Gynecol Cancer 2007; 17:524-7. [PMID: 17362324 DOI: 10.1111/j.1525-1438.2007.00792.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Peripheral primitive neuroectodermal tumor is a rare group of tumors belonging to the Ewing's family of tumors. The female genital tract is a rare site of origin and to date there are 14 reported cases in the literature. We hereby report the 15th case of uterine primitive neuroectodermal tumor in a 24-year-old multipara in the reproductive age group. A 24-year-old multipara presented with pain and mass abdomen. Physical examination revealed a pelvic mass enlarged to 20 weeks size gravid uterus, fixed, tender and hard, occupying the whole pelvis. Magnetic resonance imaging showed a large mass posterior to the uterus. She underwent panhysterectomy and debulking of the tumor. Histopathology confirmed the diagnosis. She developed recurrence of the tumor within a month and is now on chemotherapy.
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Affiliation(s)
- S Mittal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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32
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Czernobilsky B, Mamet Y, David MB, Atlas I, Gitstein G, Lifschitz-Mercer B. Uterine retiform sertoli-leydig cell tumor: report of a case providing additional evidence that uterine tumors resembling ovarian sex cord tumors have a histologic and immunohistochemical phenotype of genuine sex cord tumors. Int J Gynecol Pathol 2005; 24:335-40. [PMID: 16175078 DOI: 10.1097/01.pgp.0000170066.52604.74] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report a case of a retiform Sertoli-Leydig cell tumor of intermediate differentiation presenting as a uterine intracavity polypoid mass in a 63-year-old woman. In contrast to sertoliform endometrioid carcinoma and to hitherto reported uterine tumors resembling ovarian sex cord tumors (UTROSCTs), which are primarily characterized by tubular glands and solid tubules, this tumor, which most likely represents a UTROSCT, showed a large spectrum of histologic features typical of a genuine retiform Sertoli-Leydig cell tumor. The diagnosis was confirmed by a battery of immunohistochemical stains, which also served as a tool for differential diagnosis with other neoplasms. The tumor cells were positive for broad spectrum keratin (CK) CK18, vimentin, calretinin, and progesterone receptor. Only a few isolated cells stained for inhibin. The tumor cells were negative for CK7, CK5/6, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), thrombomodulin, 013 (CD99), melan A, alpha-fetoprotein (AFP), placental alkaline phosphatase (PLAP), alpha-1-antitrypsin, estrogen receptor, S100, neurone specific enolase (NSE), chromogranin, synaptophysin, desmin, caldesmon, and CD10. Divergent differentiation of uterine cells seems to be the most likely pathogenetic mechanism. To the best of our knowledge, no UTROSCT showing such a variety of histologic features indicative of a true sex cord tumor has been reported before.
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33
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Primitive Neuroectodermal Tumor of the Uterus: A Case Report. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Although neural and neuroendocrine tissues are distributed virtually ubiquitously throughout the body, the occurrence of selected neoplasms related to those lineages is extremely uncommon in some topographic sites. This review considers the clinicopathologic characteristics of heterotopic pituitary adenomas; neuroendocrine carcinomas in non-organ-based locations; ectopic (extraneuraxial) meningiomas and gliomas; visceral neuroblastic neoplasms and primitive neuroectodermal tumors; and paragangliomas arising outside the sympathoadrenal neural network. Practical approaches to differential diagnosis are emphasized.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology & Cytopathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908-0214, USA.
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35
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Clement PB, Young RH. Non-endometrioid carcinomas of the uterine corpus: a review of their pathology with emphasis on recent advances and problematic aspects. Adv Anat Pathol 2004; 11:117-42. [PMID: 15096727 DOI: 10.1097/00125480-200405000-00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review considers the clinical and pathologic features of the various histologic subtypes of endometrial carcinoma excluding those of pure endometrioid type, as the latter tumors were the subject of a previous contribution in the Journal (Vol. 9, No. 2). Non-endometrioid carcinomas, which account for about 10% of endometrial carcinomas, may pose a great array of problems in differential diagnosis, including their distinction not only from benign lesions but also endometrioid carcinoma and various tumors that may secondarily involve the uterine corpus. The most common subtypes are serous, mucinous, and undifferentiated. Rarer tumors are clear cell, squamous, transitional cell carcinomas, and a variety of poorly differentiated carcinomas with unusual forms of differentiation, such as hepatoid carcinoma, carcinomas with trophoblastic elements, and giant cell carcinoma. Mixed carcinomas, which are common, are also discussed, including those with a component of endometrioid carcinoma. The final section deals with endometrial involvement by metastatic tumors, lesions that, albeit rare, are sometimes neglected in the differential diagnosis of endometrial carcinomas. Important aspects emphasized are: (1) The potential for serous carcinoma to be mimicked by various forms of papillary endometrioid carcinoma. (2) The rarity of clear cell carcinoma and the greater frequency of clear cells in endometrioid carcinoma. (3) The frequency of mucinous epithelium in tumors of mixed cell type. (4) The frequency with which neoplastic mucinous epithelium originates from the endometrium. (5) The striking degree of differentiation of some squamous cell carcinomas. (6) The occasional predominance of non-endometrioid carcinomas (especially serous or undifferentiated carcinoma) within malignant mullerian mixed tumors. (7) The spectrum of reactive epithelial changes and other non-neoplastic abnormalities that may mimic serous or clear cell carcinoma.
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Affiliation(s)
- Philip B Clement
- Department of Pathology, Vancouver General Hospital and Health Science Centre and the University of Columbia, Vancouver, British Columbia, Canada.
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36
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Odunsi K, Olatinwo M, Collins Y, Withiam-Leitch M, Lele S, Spiegel GW. Primary primitive neuroectodermal tumor of the uterus: a report of two cases and review of the literature. Gynecol Oncol 2004; 92:689-96. [PMID: 14766268 DOI: 10.1016/j.ygyno.2003.09.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2002] [Indexed: 11/21/2022]
Abstract
BACKGROUND Primary primitive neuroectodermal (pPNET) tumors rarely occur in adults, and they very rarely present as primary tumors of the uterus. Only 12 reported cases of pPNET of the uterus have been published in the English literature. We report two additional cases treated at the Roswell Park Cancer Institute, Buffalo, NY, between 1999 and 2002. CASES Two postmenopausal patients presenting with abnormal uterine bleeding underwent endometrial biopsy, and subsequently staging laparotomy. The diagnosis of pPNET in both cases was confirmed only by extensive immunohistochemical analysis of the tumors. One patient with disease confined to an endometrial polyp received no adjuvant therapy, while the second patient with extrauterine disease received adjuvant pelvic radiation followed by chemotherapy. CONCLUSIONS The diagnosis of pPNET of the uterus may be a challenge. Features of diagnostic significance include positive staining with neuron-specific enolase, presence of neurosecretory granules, and positive staining with the MIC-2 gene. Currently, there is no uniformity in the treatment of these cases since the majority of the patients reported to date have had surgery, chemotherapy, and/or radiation therapy.
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Affiliation(s)
- Kunle Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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37
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Liao X, Xin X, Lü X. Primary Ewing's sarcoma–primitive neuroectodermal tumor of the vagina. Gynecol Oncol 2004; 92:684-8. [PMID: 14766267 DOI: 10.1016/j.ygyno.2003.10.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only three cases of Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) occurring in the vagina have been previously reported. CASE A 30-year-old Chinese woman presented with a vaginal mass measuring 5 cm in greatest dimension. The tumor was composed of solid sheets of undifferentiated small round cells with numerous Homer-Wright rosettes. Immunohistochemically, it was positive for CD99, FlI-1 protein, synaptophysin, neuron-specific enolase, vimentin, and S-100 protein. The patient underwent wide local excision of the tumor and subsequent total abdominal hysterectomy with postoperative chemotherapy and radiotherapy. She is disease-free 36 months after the initial surgery. CONCLUSION This is a rare case of ES-PNET occurring in the vagina and the first showing many distinctive Homer-Wright rosettes. A review of literature indicates that vaginal or vulvar ES-PNET affects younger women, and it may have a relatively favorable outcome.
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Affiliation(s)
- Xiaoyun Liao
- Department of Pathology, Peking University People's Hospital, Beijing 100044, PR China.
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38
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Doshi J, Doshi S, Disu SA, Sanusi F. A rare primitive neuroectodermal tumour presenting unusually in a postmenopausal woman. J OBSTET GYNAECOL 2003; 23:684-5. [PMID: 14617490 DOI: 10.1080/01443610310001609579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J Doshi
- Department of Obstetrics and Gynaecology, Hemel Hempstead General Hospital, UK
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39
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Gaona-Luviano P, Unda-Franco E, González-Jara L, Romero P, Medina-Franco H. Primitive neuroectodermal tumor of the vagina. Gynecol Oncol 2003; 91:456-8. [PMID: 14599885 DOI: 10.1016/s0090-8258(03)00500-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Primitive neuroectodermal tumor is grouped together with Ewing sarcoma of the bone, but its presentation includes a wider age range and more central locations than its osseous counterpart. Presentation in vagina is exceedingly rare. CASE A 34-year-old woman with personal history of kidney transplant presented with a painless vaginal mass. After surgical excision, pathology results demonstrated a primitive neuroectodermal tumor. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy. After 20 months postexcision, there is no clinical nor radiographic evidence of recurrence. CONCLUSIONS This is the second case of primitive neuroectodermal tumor located in the vagina reported in the literature.
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Affiliation(s)
- Patricia Gaona-Luviano
- Department of Gynecology, Nacional Institute of Medical Sciences and Nutrition "Salvador Zubirán," Mexico City, Mexico
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Gostout BS, Lindor NM, DiMarco CS, Peethambaram PP, Clayton AC. Pelvic primitive neuroectodermal tumor associated with a cluster of small round cell tumors: case report and review of current literature. Gynecol Oncol 2003; 91:247-53. [PMID: 14529689 DOI: 10.1016/s0090-8258(03)00416-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Peripheral primitive neuroectodermal tumor (pPNET) is aggressive and rare, comprising 1% of soft tissue sarcomas. Involvement of the reproductive tract is unusual. CASE A 35-year-old woman had a pelvic mass and omental cake. Frozen-section examination at laparotomy revealed small round cell tumor confirmed as pPNET. Chemotherapy with vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide with mesna yielded complete response. The patient's mother died of a similar tumor at age 52 years, and the patient's husband had adult Ewing sarcoma, constituting an unusual cluster of related tumors. CONCLUSIONS Genetic recombination resulting in a chimeric transcript of the Ewing sarcoma gene and the Friend leukemia virus integration site is characteristic of these tumors. Surgical resection and multiagent chemotherapy may enhance survival.
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Affiliation(s)
- Bobbie S Gostout
- Section of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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41
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Ng SB, Sirrampalam K, Chuah KL. Primitive neuroectodermal tumours of the uterus: a case report with cytological correlation and review of the literature. Pathology 2002; 34:455-61. [PMID: 12408346 DOI: 10.1080/0031302021000009397] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A case of primitive neuroectodermal tumour (PNET) co-existing with endometrial adenocarcinoma of the uterus is reported in a 48-year-old female. Histologically, the neoplastic cells formed neuroectodermal rosettes and displayed ependymal differentiation. Focal positive immunohistochemical staining for synaptophysin, chromogranin A, CD57 and cytokeratins was noted. Merging imperceptibly with the neuroectodermal component were areas of endometrial adenocarcinoma and, to the best of our knowledge, this report represents the second case of a uterine PNET with an admixed müllerian component. The patient was disease-free 6 months following surgical resection of the tumour. The literature on this uncommon entity is critically reviewed and the histogenesis, differential diagnoses and cytomorphological features of PNET are also discussed.
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Affiliation(s)
- Siok Bian Ng
- Department of Pathology, Singapore General Hospital, Singapore.
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42
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Hyun CB, Lee YR, Bemiller TA. Metastatic peripheral primitive neuroectodermal tumor (PNET) masquerading as liver abscess: a case report of liver metastasis in orbital PNET. J Clin Gastroenterol 2002; 35:93-7. [PMID: 12080235 DOI: 10.1097/00004836-200207000-00020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Adult primitive neuroectodermal tumor (PNET) of the orbit is an extremely rare malignant tumor. We report the case of a 37-year-old woman with PNET metastasis of the liver 3 years after treatment of the primary right intraconal orbital PNET with resection and chemoradiation adjuvant therapy. Literature review revealed eight previous cases of orbital PNET, but this is the first case report of liver metastasis arising from orbital PNET.
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Affiliation(s)
- Chris B Hyun
- Department of Internal Medicine, Gastroenterology Division, Naval Medical Center San Diego, California 92134-1005, USA.
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43
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Ribeiro-Silva A, Novello-Vilar A, Cunha-Mercante AM, De Angelo Andrade LAL. Malignant mixed Mullerian tumor of the uterine cervix with neuroendocrine differentiation. Int J Gynecol Cancer 2002; 12:223-7. [PMID: 11975686 DOI: 10.1046/j.1525-1438.2002.01100.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Malignant mixed Mullerian tumors (MMMTs) are rare neoplasms. We report the clinical, pathologic, and immunohistochemical features of an MMMT primary of uterine cervix. This lesion was composed of a poorly differentiated epithelial component (cytokeratin positive) and a spindle cell component (vimentin positive) with heterologous (myoblastic) differentiation (focal 1A4 positive). There were also cells with neuroendocrine features that expressed S-100 and chromogranin A. Along with a brief review of this amazing neoplasm, some histogenetic concepts relevant to this case are discussed. To our knowledge this is the first report of a malignant mixed Mullerian tumor of the uterine cervix with neuroendocrine differentiation.
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MESH Headings
- Aged
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Chemotherapy, Adjuvant
- Female
- Humans
- Hysterectomy
- Immunohistochemistry
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/therapy
- Mixed Tumor, Mullerian/diagnosis
- Mixed Tumor, Mullerian/pathology
- Mixed Tumor, Mullerian/therapy
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/therapy
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Affiliation(s)
- Alfredo Ribeiro-Silva
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP/USP), Avenida Bandeirantes, s/n-Campus Universitário Monte Alegre, CEP 14048-900, Ribeirão Preto-SP, São Paulo, Brazil.
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44
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Abstract
BACKGROUND Primitive neuroectodermal tumors (PNETs) are rare and potentially aggressive malignancies. CASE A 24-year-old woman in her eighth week of pregnancy presented with a cervical mass. Tissue biopsy demonstrated poorly differentiated carcinosarcoma with neuroendocrine features. Immunohistochemical studies confirmed the diagnosis of PNET. Treatment included alternating courses of cyclophosphamide, adriamycin, vincristine (CAV) and ifosfamide, etoposide (IE). A radical hysterectomy with bilateral ovarian transposition and periaortic lymphadenectomy was performed with postoperative chemotherapy and radiotherapy. The patient remains disease free 2 years from therapy. CONCLUSION This is a rare case of cervical PNET occurring in a pregnant patient. A review of the literature indicates that cervical PNET is distinguishable from uterine PNET. This tumor affects younger women and may have a different histogenesis. Pregnancy should not delay diagnosis of this potentially aggressive tumor.
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Affiliation(s)
- A S Tsao
- Department of Internal Medicine, Indiana University, Indianapolis, Indiana 46202-5427, USA
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45
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Nielsen GP, Young RH. Mesenchymal tumors and tumor-like lesions of the female genital tract: a selective review with emphasis on recently described entities. Int J Gynecol Pathol 2001; 20:105-27. [PMID: 11293156 DOI: 10.1097/00004347-200104000-00002] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diverse mesenchymal tumors and tumor-like lesions that occur within the female genital tract include a number of lesions that have only been recently characterized and others about which there is new information. In this group are the aggressive angiomyxoma, angiomyofibroblastoma, and cellular angiofibroma. Criteria for the distinction of these lesions are reviewed, as are the pathologic features of prognostic significance in assessing smooth muscle tumors of the vulva. The diagnostic problems that the epithelioid variant of smooth muscle tumors, both benign and malignant, may pose when they occur in various areas of the genital tract are discussed, particularly with regard to problems encountered in the ovary, a site where the diagnosis often is not considered. Recent information expanding the morphologic spectrum of fibroepithelial polyps of the genital tract is presented, and important non-neoplastic entities, including nodular fasciitis and the postoperative spindle cell nodule, are reviewed. Mesenchymal tumors of the various types seen in the soft tissues may be encountered anywhere in the female genital tract and have been the subject of particular recent interest in the ovary; issues relevant to differential diagnosis are reviewed.
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Affiliation(s)
- G P Nielsen
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Department of Pathology, Fruit Street, Boston, MA 02114, USA
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46
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Sarangarajan R, Hill DA, Humphrey PA, Hitchcock MG, Dehner LP, Pfeifer JD. Primitive neuroectodermal tumors of the biliary and gastrointestinal tracts: clinicopathologic and molecular diagnostic study of two cases. Pediatr Dev Pathol 2001; 4:185-91. [PMID: 11178636 DOI: 10.1007/s100240010141] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primitive neuroectodermal tumor (PNET) is a prototypic malignant small round cell tumor of childhood that is characterized in most cases by t(11;22) resulting in an EWS-FLI1 gene fusion. Once thought to be uncommon, PNET now accounts for almost 20% of malignant soft tissue tumors in children. Increased recognition of PNET is partly due to advances in immunohistochemistry and molecular diagnostics, which have led to the identification of the tumor in non-classical sites. We report the clinical, histologic, immunohistochemical, and molecular findings of two visceral PNETs of the digestive system--one involving the small intestine and the other involving the hepatic duct. Histologically, each tumor was composed of malignant small cells growing in sheets, nests, and lobules; the tumor cells of both cases showed characteristic immunoreactivity for vimentin and O13 (CD99). Reverse transcription-polymerase chain reaction (RT-PCR) analysis for t(11;22) using nested primers was performed with RNA extracted from paraffin-embedded, formalin-fixed tissue and demonstrated an EWS exon 7 to FLI1 exon 5 fusion in both cases, confirmed by Southern blot hybridization and DNA sequence analysis. These results illustrate the expanded clinicopathologic profile of PNET, and demonstrate that visceral PNETs, despite their unusual sites of presentation, maintain the characteristic immunohistochemical and genetic features of PNETs at more conventional sites.
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MESH Headings
- Adolescent
- Bile Duct Neoplasms/chemistry
- Bile Duct Neoplasms/genetics
- Bile Duct Neoplasms/pathology
- Biomarkers, Tumor/analysis
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Female
- Hepatic Duct, Common/pathology
- Humans
- Immunoenzyme Techniques
- Jejunal Neoplasms/chemistry
- Jejunal Neoplasms/genetics
- Jejunal Neoplasms/pathology
- Male
- Neoplasm Proteins/analysis
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/chemistry
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- RNA, Neoplasm/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Analysis, DNA
- Wilms Tumor/pathology
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Affiliation(s)
- R Sarangarajan
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO 63110-1093, USA
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47
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Hofman V, Chevallier A, Motamedi JP, Michiels JF, Hofman P, Isnard V, Hassoun J. Pelvic ependymoma arising from the small bowel. Pathology 2001. [DOI: 10.1080/00313020124366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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49
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Sinkre P, Albores-Saavedra J, Miller DS, Copeland LJ, Hameed A. Endometrial endometrioid carcinomas associated with Ewing sarcoma/peripheral primitive neuroectodermal tumor. Int J Gynecol Pathol 2000; 19:127-32. [PMID: 10782408 DOI: 10.1097/00004347-200004000-00005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Three uterine tumors, each consisting of endometrioid carcinoma and Ewing's sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) are described. The diagnosis of ES/pPNET in each case was first established in the hysterectomy specimen because each ES/pPNET was misinterpreted on the endometrial biopsy specimens as a high-grade homologous sarcoma. The ES/pPNET element in each case consisted of solid masses of small- to medium-sized round cells without Homer-Wright pseudorosettes, glial or ganglion cells, true rosettes with central lumens, or medulloepithelial tubules. Each ES/pPNET exhibited focal positive immunostaining for neuron-specific enolase, diffuse staining for vimentin, and strong cell membrane immunoreactivity for O13 (CD99), the last finding providing the first clue to the diagnosis of ES/pPNET in each case. The diagnosis in each case was confirmed by detection of EWS/FLI-1 fusion transcript through reverse transcription polymerase chain reaction. We also examined O13 immunoreactivity retrospectively in 40 cases of malignant mixed mullerian tumors (MMMT) with homologous or heterologous elements. O13 immunoreactivity was not observed in the malignant epithelium or in the homologous or heterologous sarcomas. The immunoreactivity of O13 in round cell endometrial sarcomas provides a clue to the diagnosis of ES/pPNET.
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MESH Headings
- 12E7 Antigen
- Aged
- Antigens, CD/analysis
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/pathology
- Cell Adhesion Molecules/analysis
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/pathology
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Mixed Tumor, Mullerian/diagnosis
- Mixed Tumor, Mullerian/pathology
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/pathology
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1
- RNA, Messenger/analysis
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Transcription Factors/genetics
- Uterine Neoplasms/diagnosis
- Uterine Neoplasms/pathology
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Affiliation(s)
- P Sinkre
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9073, USA
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50
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Vang R, Taubenberger JK, Mannion CM, Bijwaard K, Malpica A, Ordonez NG, Tavassoli FA, Silver SA. Primary vulvar and vaginal extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor: diagnostic confirmation with CD99 immunostaining and reverse transcriptase-polymerase chain reaction. Int J Gynecol Pathol 2000; 19:103-9. [PMID: 10782405 DOI: 10.1097/00004347-200004000-00002] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two cases of extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor arising in unusual, superficial sites are reported. One tumor involved the vaginal wall of a 35-year-old woman, and the other neoplasm arose in the dermis of the vulva in a 28-year-old woman. The tumors showed characteristic microscopic features of Ewing's sarcoma/peripheral neuroectodermal tumor with nodular monotonous proliferations of undifferentiated, small, round, hyperchromatic cells with a low mitotic index. Rare rosette-like formations were apparent only in the vulvar neoplasm. The tumors displayed intense immunoreactivity in a membranous pattern for CD99, the cell surface glycoprotein encoded by the MIC2 gene. Genetically, the tumors expressed the EWS/FLI-1 chimeric transcript, derived from the t(11;22)(q24;q12) chromosomal translocation. Both patients had localized disease treated with wide local excision; one received postoperative chemotherapy, and the other received chemotherapy and radiotherapy. To date, 18 and 19 months after diagnosis, neither patient has had clinical evidence of local recurrence or metastasis. To our knowledge, these are the first reported cases of vaginal and vulvar Ewing's sarcoma/peripheral neuroectodermal tumor, confirmed with molecular genetic analysis, in the English literature.
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MESH Headings
- 12E7 Antigen
- Adult
- Antigens, CD/analysis
- Antineoplastic Agents/therapeutic use
- Cell Adhesion Molecules/analysis
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Female
- Humans
- Immunohistochemistry
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/genetics
- Neuroectodermal Tumors/therapy
- Radiotherapy
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/therapy
- Surgical Procedures, Operative
- Translocation, Genetic
- Vaginal Neoplasms/diagnosis
- Vaginal Neoplasms/genetics
- Vaginal Neoplasms/therapy
- Vulvar Neoplasms/diagnosis
- Vulvar Neoplasms/genetics
- Vulvar Neoplasms/therapy
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Affiliation(s)
- R Vang
- Department of Pathology, University of Texas Medical School, Houston, USA
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