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Wei D, Jianguo Z, Xiao L, Pengpeng Q. Primary primitive neuroectodermal tumor of the cervix confirmed with molecular analysis in a pregnant woman: A case report and literature review. Front Genet 2022; 13:871531. [PMID: 36035131 PMCID: PMC9399424 DOI: 10.3389/fgene.2022.871531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Primary primitive neuroectodermal tumor (PNET) in the female tract is rare. Recently, a case of cervical PNET was diagnosed in our hospital. A 29-year-old pregnant woman presented with a cystic-solid cervical mass at the 7th week of gestation. The mass grew rapidly during follow-up and ruptured at the 22nd week. A biopsy was performed on the mass. Pathological examination revealed a malignant neoplasm composed of small cells which exhibited positive immunohistochemical (IHC) staining for CD99, SYN, and FLI1. Fluorescence in situ hybridization (FISH) displayed the presence of EWS-FLI1 fusion gene resulting from the chromosomal translocation t (11;22, q24;q12), which confirmed the diagnosis of cervical PNET. The reverse transcription-polymerase chain reaction (RT-PCR) results showed type 2 EWS-FLI1 fusion occurred in this tumor, suggesting a poor prognosis. The patient underwent surgical resection and was given adjuvant chemotherapy followed by pelvic radiotherapy. PNET arising from the genital tract, especially in the uterine cervix, is very rare and presents a diagnostic challenge. FISH and RT-PCR analysis are helpful for the diagnosis of such a tumor at an unusual site, as in the present case.
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Affiliation(s)
- Ding Wei
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Zhao Jianguo
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Li Xiao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Qu Pengpeng
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China
- *Correspondence: Qu Pengpeng,
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2
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Kulkarni RV, Nayak B, Mishra J, Parija J, Senapathy S, Giri SK. Peripheral Primitive Neuroectodermal Tumor of Uterus: A Case Report. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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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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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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5
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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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6
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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: 35] [Impact Index Per Article: 5.0] [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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7
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Novo J, Bitterman P, Guirguis A. Central-type primitive neuroectodermal tumor of the uterus: Case report of remission of stage IV disease using adjuvant cisplatin/etoposide/bevacizumab chemotherapy and review of the literature. Gynecol Oncol Rep 2015; 14:26-30. [PMID: 26793768 PMCID: PMC4688884 DOI: 10.1016/j.gore.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/30/2015] [Accepted: 09/13/2015] [Indexed: 12/21/2022] Open
Abstract
Bevacizumab was an effective agent in one case of advanced uterine PNET. VEGF was expressed by the tumor, supporting a mechanism for effectiveness. Cisplatin/etoposide/bevacizumab should be further studied in clinical trials. Patient remains disease-free forty-eight months following intervention.
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Affiliation(s)
- Jorge Novo
- Rush University Medical Center, Department of Pathology, 1653 West Congress Parkway, 570 Jelke, Chicago, IL 60612, United States
| | - Pincas Bitterman
- Rush University Medical Center, Department of Pathology, 1653 West Congress Parkway, 570 Jelke, Chicago, IL 60612, United States
| | - Alfred Guirguis
- Gynecologic Cancer Institute of Chicago, 5716 W 95th Street, Oak Lawn, IL 60453, United States
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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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9
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Dizon AM, Kilgore LC, Grindstaff A, Winkler M, Kimball KJ. High grade primitive neuroectodermal tumor of the uterus: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 7:10-2. [PMID: 24624321 PMCID: PMC3895281 DOI: 10.1016/j.gynor.2013.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Indexed: 01/12/2023]
Abstract
Primitive neuroectodermal tumor of the uterus is extremely rare. Diagnosis requires timely evaluation with molecular analysis. Different combinations of adjuvant chemotherapy have been reported.
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Affiliation(s)
- A Mitch Dizon
- Department of Obstetrics and Gynecology, The University of Tennessee Medical Center, 1928 Alcoa Highway, Suite B-118, Knoxville, TN 37920, USA
| | - Larry C Kilgore
- Division of Gynecologic Oncology, The University of Tennessee Medical Center, 1926 Alcoa Highway, Building F, Suite 370, Knoxville, TN 37920, USA
| | - Alan Grindstaff
- Department of Pathology, The University of Tennessee Medical Center, 1924 Alcoa Highway, Box 108, Knoxville, TN 37920, USA
| | - Marcus Winkler
- Department of Pathology, The University of Tennessee Medical Center, 1924 Alcoa Highway, Box 108, Knoxville, TN 37920, USA
| | - Kristopher J Kimball
- Division of Gynecologic Oncology, The University of Tennessee Medical Center, 1926 Alcoa Highway, Building F, Suite 370, Knoxville, TN 37920, USA
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10
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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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11
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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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12
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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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13
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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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14
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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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15
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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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16
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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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17
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Uterine primitive neuroectodermal tumor: a case report. Arch Gynecol Obstet 2008; 279:259-61. [DOI: 10.1007/s00404-008-0699-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 05/20/2008] [Indexed: 10/22/2022]
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18
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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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19
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Blattner JM, Gable P, Quigley MM, McHale MT. Primitive neuroectodermal tumor of the uterus. Gynecol Oncol 2007; 106:419-22. [PMID: 17537492 DOI: 10.1016/j.ygyno.2007.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 03/28/2007] [Accepted: 04/01/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND : Primitive peripheral neuroectodermal tumors (PNETs) of the uterus are rare. Recent data have demonstrated improved response rates with adjuvant chemotherapy. CASE : A 26-year-old, gravida 2, para 1, Filipina female underwent an emergent cesarean section for fetal indications. Intraoperative findings were remarkable for a soft tissue mass in the lower uterine segment. Histologic features, immunohistochemical findings, and chromosomal analysis were consistent with a PNET. The patient underwent radical surgery, adjuvant chemotherapy with vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide (VAC/IE), and whole pelvic radiation therapy. CONCLUSION : Only 14 case reports of primitive neuroectodermal tumors of the uterus have been published in the English literature to date. No definitive conclusions concerning the therapeutic management and prognosis have been ascertained.
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Affiliation(s)
- Jennifer Milspaw Blattner
- Department of Obstetric and Gynecology, Naval Medical Center San Diego, San Diego, CA 92134-1005, USA
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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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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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Abstract
A case of primitive neuroectodermal tumor arising in the uterine corpus of a 43-year-old woman is presented. The tumor mass was 13.3 cm and extended to the uterine serosa, endocervical stroma, and left adnexa. Histologically, the tumor was composed of small blue cells with scant cytoplasm, indistinct cell borders, hyperchromatic round nuclei, and inconspicuous nucleoli focally forming pseudorosettes, suggestive of neuroectodermal origin. The tumor cells displayed strong immunoreactivity for CD99 and FLI1. Cytogenetic fluorescence in situ hybridization study revealed presence of an EWS-FLI1 fusion gene. To the best of our knowledge, this is the first case of primitive neuroectodermal tumor of the uterus with diagnosis confirmed by FLI1 immunohistochemical labeling and demonstration of t (11; 22) by fluorescence in situ hybridization.
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Affiliation(s)
- Linda Varghese
- Department of Pathology, Allina Hospitals and Clinics Pathology Associates, Minneapolis, MN 55455, USA.
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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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