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Mousavi SR, Farrokhi MR, Eghbal K, Dehghanian A, Rezvani A, Ghaffarpasand F. Metastatic thoracic and lumbar intramedullary and extramedullary Ewing's sarcoma: a rare case report and literature review. J Int Med Res 2022; 50:3000605221108095. [PMID: 35938475 PMCID: PMC9364211 DOI: 10.1177/03000605221108095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ewing sarcoma (ES) is a highly aggressive bone and soft tissue tumor that occurs
mainly in young children and adolescents and is associated with primary and
metastatic disease. Intramedullary ES (either primary or secondary) is rare, and
the ideal management remains inconclusive. We herein report intramedullary and
extramedullary metastatic ES in a single patient. A 46-year-old woman was
referred to our outpatient clinic from the oncology clinic with progressive
paraparesis and paresthesia for 1 week prior to presentation. She had developed
left clavicular ES 2 years earlier for which surgery and chemoradiotherapy had
been performed. At the present evaluation, she was diagnosed with intramedullary
thoracic and lumbar extradural masses. Thoracic surgery was performed, and a
biopsy of the lesion was obtained. The diagnosis of ES was confirmed
histopathologically, and she underwent adjuvant chemotherapy. Her neurological
status did not improve after surgery, and she underwent rehabilitation and
physical therapy. The lumbar lesion resolved with chemotherapy. Metastasis of ES
to the spinal cord, especially intramedullary lesions, is extremely rare, and
there is no standard management guideline. However, surgical decompression and
adjuvant chemotherapy are the main treatments in these cases.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Trauma research center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Troschel FM, Kröger K, Siats JJ, Rahbar K, Eich HT, Scobioala S. The Role of Neuroaxis Irradiation in the Treatment of Intraspinal Ewing Sarcoma: A Review and Meta-Analysis. Cancers (Basel) 2022; 14:1209. [PMID: 35267515 PMCID: PMC8909708 DOI: 10.3390/cancers14051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
The role of cranio-spinal irradiation (CSI) for primary extraosseous intraspinal Ewing sarcoma (EwS) remains unclear. Here, we evaluate clinical and survival outcomes in patients with primary intraspinal EwS treated with CSI as part of multimodal primary therapy regimens. We abstracted patient information, including details on treatment application, efficacy, and tolerance from the literature and our hospital database for a cohort of 24 primary intraspinal EwS patients treated with CSI. Median age was 25.5 years, median CSI dose was 36 Gy and mean boost dose was 12.8 Gy. Sixteen patients (66.7%) achieved complete radiological remission, another 5 patients demonstrated partial response and 1 patient showed no response to treatment. Compared to a cohort of patients treated with focal radiotherapy, CSI patients were more likely to have multifocal disease at time of diagnosis (p = 0.001) and intradural tumor location (p < 0.001). Despite over-representation of these unfavorable characteristics, there was no survival difference between groups (p = 0.58). While CSI shows promising results in the treatment of primary intraspinal EwS, treatment should be considered individually based on tumor and patient characteristics in the absence of prospective trials.
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Affiliation(s)
- Fabian M. Troschel
- Department of Radiation Oncology, Münster University Hospital, 48149 Münster, Germany; (K.K.); (J.J.S.); (H.T.E.)
| | - Kai Kröger
- Department of Radiation Oncology, Münster University Hospital, 48149 Münster, Germany; (K.K.); (J.J.S.); (H.T.E.)
| | - Jan J. Siats
- Department of Radiation Oncology, Münster University Hospital, 48149 Münster, Germany; (K.K.); (J.J.S.); (H.T.E.)
| | - Kambiz Rahbar
- Department of Nuclear Medicine, Münster University Hospital, 48149 Münster, Germany;
| | - Hans Theodor Eich
- Department of Radiation Oncology, Münster University Hospital, 48149 Münster, Germany; (K.K.); (J.J.S.); (H.T.E.)
| | - Sergiu Scobioala
- Department of Radiation Oncology, Münster University Hospital, 48149 Münster, Germany; (K.K.); (J.J.S.); (H.T.E.)
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Patil AS, Gupta PP, Iratwar SW. Primary Spinal Extradural Extraosseous Primitive Neuroectodermal Tumor/Ewing's Sarcoma: A Critical Analysis and Review. Asian J Neurosurg 2021; 16:276-280. [PMID: 34268151 PMCID: PMC8244703 DOI: 10.4103/ajns.ajns_340_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/08/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022] Open
Abstract
Primary spinal extradural Ewing's sarcoma/primitive neuroectodermal tumor (PNET) is rare malignant tumor of childhood and early adulthood. The World Health Organization classifies PNET as an undifferentiated round cell tumor arising from primitive neuroepithelial cell. It can be central or peripheral PNET depending on site of presentation. Usually, the presenting symptoms are chronic back pain and myelopathy. Overall prognosis and survival are dismal in spite of total surgical resection and adjuvant therapy. Because of the rarity and malignant behavior, definite management of spinal PNET has never been described. After review of medical record at Acharaya Vinoba Bhave Rural Hospital, Sawangi, India, we identified four patients of spinal PNET and were included in our study. Age at diagnosis ranging from 15 to 26 years old with mean age of 20 years old. All four cases were epidural in location, two of which were of Askin type tumor with spinal cord compression. Rural population with low literacy and financial constraints were the key reasons of late presentations at our hospital. Counseling and proper education regarding the disease are a must for early case detection and early treatment of those living in rural areas and suffers from financial constraints. Due to rarity of the disease and its poor prognosis, a well-organized multicentric controlled trial is required to formulate a standard guidelines in the management of this disease.
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Fukushima K, Tsuji O, Suzuki S, Nori S, Nagoshi N, Okada E, Yagi M, Emoto K, Nakayama R, Watanabe K, Nakamura M, Matsumoto M. Cervical intramedullary recurrent Ewing sarcoma after 10-year disease-free survival in an adult: a case report and review of literature. Spinal Cord Ser Cases 2021; 7:45. [PMID: 34045432 DOI: 10.1038/s41394-021-00406-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Intramedullary metastasis of Ewing sarcoma is extremely rare. Here, we report an adult case of cervical intramedullary recurrent Ewing sarcoma after a 10-year disease-free survival after the initial surgery for a thoracic lesion. CASE PRESENTATION A 39-year-old man with a history of surgery and chemoradiotherapy for thoracic Ewing sarcoma ten years ago presented with neck pain and incomplete motor paralysis in the right upper extremity, which had suddenly appeared three months before. Cervical magnetic resonance imaging revealed a tear-drop-shaped intramedullary lesion at the C3 level accompanied by diffuse edematous change. Because of the rapid progression of his myelopathy, he underwent surgery for this intramedullary lesion. Intraoperatively, the tumor exhibited an orangish exophytic appearance. The unclearness of the tumor boundary compelled us to perform a partial resection. The histopathology showed the tumor comprised small round atypical cells with immunoreactivity for Nkx2.2 and CD99, diagnosing a metastatic Ewing sarcoma. Postoperatively, although his myelopathy improved transiently and adjuvant chemotherapy radiation was undergone, he died of cranial dissemination of the tumor two months and a half later. DISCUSSION To our knowledge, 31 cases of primary and only 4 cases of recurrent intramedullary spinal Ewing sarcoma have been reported to date; however, this is the first case of recurrent intramedullary Ewing sarcoma with a 10-year disease-free survival. Sadly, the prognosis of the current case was extremely poor. There is no clear treatment guideline for recurrent intramedullary Ewing sarcoma because of its rarity, and further collection of similar cases would be required.
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Affiliation(s)
- Keita Fukushima
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Katsura Emoto
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Ma J, Ma S, Yang J, Jia G, Jia W. Primary spinal primitive neuroectodermal tumor: A single center series with literature review. J Spinal Cord Med 2020; 43:895-903. [PMID: 30561250 PMCID: PMC7801045 DOI: 10.1080/10790268.2018.1547862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Primary spinal primitive neuroectodermal tumor (PNET) of the central nervous system has a low incidence. The intraspinal case is very rare. Around 30 cases have been reported so far. We summarized the cases of primary spinal PNET available in the database of our institute, either intramedullary or extramedullary cases. Then we did literature review of the same disease. Findings: There were eight cases of primary spinal PNET available in our database, with one intramedullary case and seven extramedullary cases. Surgical resection was performed. The histology diagnosis was PNET. Peri-operative image examinations of the whole central nervous system (CNS) were performed to exclude tumors other than spinal cord origin. Then during literature review, 33 reports of the disease were included. The pre-operative diagnosis rate was low. The disease had a high recurrence rate and poor prognosis given available treatment. Conclusion: Primary spinal primitive neuroectodermal tumor is of high malignancy. Little is known due to its quite low incidence. The prognosis is poor due to lacking of effective treatment strategy. Present treatment strategy is referred to other common CNS malignancies like glioma. Further investigation of the disease is necessary.
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Affiliation(s)
- Jun Ma
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, People’s Republic of China
| | - Shunchang Ma
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, People’s Republic of China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, People’s Republic of China
| | - Guijun Jia
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, People’s Republic of China
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People’s Republic of China,National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, People’s Republic of China,Correspondence to: Wang Jia, Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, Dongcheng District Tiantanxili No. 6, Beijing, People’s Republic of China. Ph: (86)-10-67098431.
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Chen X, Zhang G. Multiple Spinal Intramedullary Primitive Neuroectodermal Tumors Mimicking Acute Myelitis. World Neurosurg 2019; 126:72-75. [PMID: 30831283 DOI: 10.1016/j.wneu.2019.02.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Primitive neuroectodermal tumors (PNETs) are rare malignant neoplasms in the spinal cord that comprise undifferentiated or poorly differentiated neural crest cells. PNETs imaging findings lack specificity, making diagnosis difficult. CASE DESCRIPTION A 16-year-old male patient presented with progressive weakness and numbness of the lower extremities for 1 month, which occurred after a cold. Significantly elevated protein levels were detected in his cerebrospinal fluid. Magnetic resonance imaging revealed multiple patchy or spindle-shaped hyperintensities on T2-weighted imaging, which is similar to acute myelitis imaging findings. However, the effect of hormone treatment was minimal. Enhanced magnetic resonance imaging with gadolinium-diethylenetriamine pentaacetic acid showed significant enhancement of intramedullary lesions and the meninges, which was diagnosed as tuberculosis and tuberculous meningitis. After therapy with quadruple antituberculosis treatment for 1 week, however, the T-spot was negative. Therefore, the antituberculosis regimen was ceased. Atypical cells were observed in cerebrospinal fluid from a third lumbar puncture. Next, most of the thoracic intramedullary lesions were resected. By histopathology, these lesions manifested as PNETs. CONCLUSIONS This paper reports a very rare case of PNETs with multiple lesions in the spinal cord that mimicked acute myelitis and emphasizes that multiple PNETs lesions detected by magnetic resonance imaging could have an initial acute myelitis-like presentation, which should be considered a differential diagnosis.
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Affiliation(s)
- Xiaoli Chen
- Department of Neurology, Shaanxi Provincial People's Hospital, Shaanxi Province, China
| | - Guoping Zhang
- Department of Radiology, Shaanxi Provincial People's Hospital, Shaanxi Province, China.
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7
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Nery B, Pereira LCT, Costa RAF, Queiroz RM, Abud LG, Quaggio E, Coronatto LH, Prado IST, Miyake CH, Filho FB. Cervicomedullary primitive neuroectodermal tumor of the spine: Case report. Surg Neurol Int 2019; 9:241. [PMID: 30595962 PMCID: PMC6287338 DOI: 10.4103/sni.sni_41_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/23/2018] [Indexed: 11/04/2022] Open
Abstract
Background Intramedullary primitive neuroectodermal tumors (PNETs) are tumors found rarely in the cervical region, with only five such cases described in the literature. The available literature contains only one report regarding cervicomedullary junction PNET. Case Description The authors present a case report of a 45-year-old male patient who had undergone urgent hospitalization owing to progressive tetraparesis and subtle impairment of respiratory function. He underwent magnetic resonance imaging, which showed an extensive enhancing cervical intramedullary tumor extending from C5 to the bulbar region. Since he developed severe impairment of respiratory function, he required tracheostomy. He then underwent microsurgery 2 days after his admission, and a partial tumor resection was performed. The pathological diagnosis of PNET of the cervicomedullary junction (CMJ) was made. He had slight worsening of strength after surgery with subsequent deterioration over the next 3 weeks. The tumor displayed aggressive growth; thus, radiotherapy was indicated. Unfortunately, he developed severe febrile neutropenia and died after 2 weeks of radiotherapy. Given the rarity of the condition, we wish to review the epidemiology, pathophysiology, and treatment options of his population. Conclusion Intramedullary PNETs of the cervical spine and CMJ are exceedingly rare in adults; treatment of such patients remains a challenge, despite the modern neurosurgical armamentarium that is available.
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Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Lucas Giansante Abud
- Department of Radiology, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Quaggio
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Fred Bernardes Filho
- Department of Internal Medicine, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
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Abstract
RATIONALE Primary spinal primitive neuroectodermal tumors (PNETs) are highly malignant tumors, which are extremely rare entities and primary intramedullary PNETs are extremely rare. Till now, only 24 cases of primary intramedullary PNET have been reported. PATIENT CONCERNS A 26-year-old male presented with progressive low back and lower limb pain for 1 month. DIAGNOSES Based on MRI and histopathological findings, he was diagnosed with primary intramedullary PNET. INTERVENTIONS The patient was treated two times with microsurgical resections. OUTCOMES Follow-up visit at 14 months after the first surgery showed that the patient is neurologically intact and free of disease. LESSONS PNETs should be considered in the differential diagnosis of an intramedullary spinal cord tumor manifesting as progressive neurological deterioration.
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Affiliation(s)
| | - Fuyou Guo
- Department of Neurosurgery
- Department of Neurosurgery, Key Laboratory of Neurosurgical Diseases, The First Affiliated Hospital of Zhengzhou University, ZhengZhou, HeNan Province, PR China
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9
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Clinical presentation and long-term outcome of primary spinal peripheral primitive neuroectodermal tumors. J Neurooncol 2015; 124:455-63. [PMID: 26186903 DOI: 10.1007/s11060-015-1859-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/12/2015] [Indexed: 12/25/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare entities that predominantly occur in children and young adults. Few studies have reported more than three cases. There are no current optimum treatment strategies due to the paucity of data. Here, we present 13 patients (nine females and four males) with primary intraspinal pPNETs who were surgically treated from April 2008 to February 2014. Histopathologic findings revealed the expression of CD99 in all cases. Limb weakness was the most common initial symptom (11/13, 85 %). The tumors were located mainly at the cervical level (6/13, 46 %) and in the epidural space (10/13, 77 %). The radiological diagnosis was neurinoma or meningioma in most cases (10/13, 77 %). Gross total resection was achieved in 77 % (10/13) of patients. During a mean follow-up of 25.5 months, local relapse occurred in 8 (61.5 %) patients and distant metastases occurred in 8 (61.5 %) patients. The overall 1-year survival rate was 77 % (10/13), and the overall 2-year survival rate was 54 % (7/13). The 2-year survival rate was 57.1 % in patients with adjuvant chemotherapy and 50 % in those without chemotherapy. Gross total resection and adjuvant radiotherapy with or without chemotherapy demonstrated a longer survival period (1-year survival rate: 100 %; 2-year survival rate: 86 %). Our data showed that primary spinal pPNETs are extremely rare and aggressive tumors with a poor prognosis. Radical resection is advocated. Gross total resection combined with adjuvant radiation may help to significantly improve patient survival period. Chemotherapy may also help to slightly prolong patient life.
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10
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Chan SHS, Tsang DSF, Wong VCN, Chan GCF. Spinal primitive neuroectodermal tumor mimicking as chronic inflammatory demyelination polyneuropathy: a case report and review of literature. J Child Neurol 2015; 30:254-8. [PMID: 24659733 DOI: 10.1177/0883073814527160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a young boy who presented with progressive weakness of lower extremities associated with areflexia and abnormal electrophysiological findings initially suggestive of chronic inflammatory demyelinating polyneuropathy. Initial lumbosacral spinal magnetic resonance imaging (MRI) showed thickened descending spinal nerve roots only. Immunomodulating therapy was given but with limited clinical response. Repeated spine magnetic resonance imaging showed cauda equina and also new spinal cord extramedullary contrast enhancement. The initial extensive investigations including open biopsy did not point to any specific diagnosis. Only through pursuing a repeated biopsy, the diagnosis of the spinal peripheral primitive neuroectodermal tumor was confirmed. This case highlights the diagnostic challenges of the spinal peripheral primitive neuroectodermal tumor that could have an initial chronic inflammatory demyelinating polyneuropathy-like presentation. The literature review confirms that this is a rare condition and cauda equina origin has only been reported in adults and teenagers, and this is the first reported case in a young child.
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Affiliation(s)
- Sophelia H S Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Dickson S F Tsang
- Department of Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Virginia C N Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Godfrey C F Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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11
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Menashe SJ, Iyer RS. Pediatric Spinal Neoplasia: A Practical Imaging Overview of Intramedullary, Intradural, and Osseous Tumors. Curr Probl Diagn Radiol 2013; 42:249-65. [DOI: 10.1067/j.cpradiol.2013.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Hung SC, Lu YJ, Lin SC, Ho DMT, Guo WY, Chang CY. Imaging characteristics of primary spinal primitive neuroectodermal tumors. A report of five cases and literature review. Neuroradiol J 2013; 25:604-9. [PMID: 24029097 DOI: 10.1177/197140091202500515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 09/23/2012] [Indexed: 11/16/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are rare and classified into peripheral and central types because the treatment strategy and outcome are different. This study describes five cases of primary spinal peripheral type PNETs. Magnetic resonance imaging showed large extradural masses in the cervical and thoracic spine with bony invasion and paraspinal extension in four cases and a transdural mass in the sacral spinal canal in one case. We also briefly summarize the imaging characteristics of 36 peripheral type and six central type primary spinal PNETs in the literature.
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Affiliation(s)
- S-C Hung
- Department of Radiology, Taipei Veterans General Hospital; Taipei, Taiwan - National Yang-Ming University; Taipei, Taiwan -
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13
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Tsutsumi S, Nonaka Y, Abe Y, Yasumoto Y, Nakazato Y, Ito M. Intramedullary primitive neuroectodermal tumor presenting with rapidly-progressive cauda equina syndrome. Neurol Med Chir (Tokyo) 2013; 50:1031-5. [PMID: 21123993 DOI: 10.2176/nmc.50.1031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 39-year-old male presented with gait disturbances with rapid deterioration for 2 weeks. Neurological examination found paraparesis, sensory loss in the L1-S5 dermatomes, and vesicorectal dysfunction. Magnetic resonance (MR) imaging revealed a fusiform intramedullary tumor at T12-L1 levels with heterogeneous enhancement. The patient underwent microsurgical tumor resection. A myelotomy exposed a highly vascular tumor that was subtotally resected. Histological examination demonstrated hypercellular tumor accompanied by significant cell atypism and mitotic figures. Immunohistochemical staining was positive for glial fibrillary acidic protein, S-100 protein, synaptophysin, and INI-1, consistent with primitive neuroectodermal tumor (PNET). Postoperatively, the patient underwent irradiation to the whole craniospinal axis. He experienced local recurrence 7 months after surgery. MR imaging performed at 10 months revealed holocord progression and intracranial dissemination. The patient died 13 months after the onset of the disease. PNET should be considered in the differential diagnosis of an intramedullary spinal cord tumor.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
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14
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Aydin MV, Sen O, Ozel S, Kayaselcuk F, Caner H, Altinors N. Primary primitive neuroectodermal tumor within the spinal epidural space: report of a case and review of the literature. Neurol Res 2013; 26:774-7. [PMID: 15494121 DOI: 10.1179/016164104225014111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Primary intraspinal primitive neuroectodermal tumors (PNETs) are rare tumors and a have poor prognosis. In reviews of the literature, it is seen that primary intraspinal PNETs may arise at all levels of the spine and may be intramedullary, intradural-extramedullary, or epidural. Spinal epidural location of PNET is extremely rare and out of 22 cases of primary spinal PNETs reported to date, only two were epidural. Tumors within the epidural space of the spinal canal are most often metastatic neoplasms from different primary sites. Here we report a case of primary extradural PNET located in the thoracic spine in a 16-year-old boy and review the relevant literature.
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Affiliation(s)
- M Volkan Aydin
- Department of Neurosurgery, Medical Faculty, Baskent University, Adana, Turkey.
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15
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Ghanta RK, Koti K, Ghanta VSK, Teegala R. Intracranial metastasis from primary spinal primitive neuroectodermal tumor. Asian J Neurosurg 2013; 8:42-7. [PMID: 23741262 PMCID: PMC3667460 DOI: 10.4103/1793-5482.110279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumors (PNET) are rare tumors, with only 94 cases reported till date. Metastasis to brain from a spinal PNET is even rarer. In the present report, we evaluate the pathology and treatment of solitary intracranial metastasis from spinal PNET in a 22-year-old female who presented with headache and left hemiparesis and was diagnosed to have right parietal parasagittal tumor. She has been previously diagnosed to have cervicothoracic primary spinal PNET, and was treated by surgery, radiotherapy, and chemotherapy seven years back. The intracranial tumor has been removed and pathological examination confirmed as PNET. She received radiotherapy and chemotherapy with ifosfamide and etoposide, following surgery for the right parietal PNET. At 20 months follow-up, patient is stable and has no recurrence of the disease. Critical review of reported cases of primary spinal PNET metastsising to brain was done.
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Affiliation(s)
- Rajesh Kumar Ghanta
- Department of Neurosurgery, Suraksha Hospital, Vijayawada, Andhra Pradesh, India
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Alexiou GA, Siozos G, Stefanaki K, Moschovi M, Prodromou N. Intramedullary spinal cord primitive neuroectodermal tumor presenting with hydrocephalus. J Child Neurol 2013; 28:246-50. [PMID: 22532539 DOI: 10.1177/0883073812441061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spinal primitive neuroectodermal tumors are exceedingly rare. Herewith, we present the first case of an intramedullary spinal cord tumor associated with hydrocephalus in a 2-month-old boy that presented with left hemiparesis. The patient had been diagnosed on prenatal ultrasound with enlarged ventricular system. At his current admission, a brain magnetic resonance imaging (MRI) revealed hydrocephalus and an intramedullary lesion extending from the second cervical to the first thoracic vertebrae. Dissemination of the tumor was revealed intracranially and in the spinal canal. After a ventriculoperitoneal shunt placement a radical resection of the tumor was performed, however some small tumor remnants could not be safely removed. Postoperative there was no neurologic deterioration. The tumor was diagnosed as a central nervous system primitive neuroectodermal tumor (World Health Organization grade IV). Spinal intramedullary primitive neuroectodermal tumors are extremely rare. In such rare tumors, multiinstitutional studies are needed for treatment guidelines to be established.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, Children's Hospital Agia Sofia, Athens, Greece.
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17
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Primary spinal primitive neuroectodermal tumour: report of two cases mimicking neurofibroma and review of the literature. Neurol Neurochir Pol 2012; 46:480-8. [PMID: 23161193 DOI: 10.5114/ninp.2012.31360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary spinal primitive neuroectodermal tumours (PNETs) are a rare entity. Most of them occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. We present two cases of primary spinal PNET. In both cases, the tumours were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. These tumours are highly aggressive with rapid growth as evidenced by the short history in both of our cases. Both cases underwent gross total removal of the intraspinal and thoracic components. Postoperatively, both patients underwent cranio-spinal radiotherapy. A review of the literature shows that the overall prognosis of PNETs of the spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. One patient died after 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.
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18
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Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are rare tumors. Most of these tumors occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. These tumors are highly aggressive with rapid growth. Review of the literature shows that the overall prognosis of PNETs of spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. All the cases reported to date are reviewed in terms of surgical treatment, adjuvant therapy and outcome and the experience with two of these cases are described. Both cases were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. Both cases underwent gross total removal of intraspinal and thoracic component. Post-operatively both underwent cranio-spinal radiotherapy. One patient died after a post-operative period of 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.
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Affiliation(s)
- Ashis Patnaik
- Department of Neurosurgery, SCB Medical College & Hospital, Cuttack, Odisha, India.
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19
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Saeedinia S, Nouri M, Alimohammadi M, Moradi H, Amirjamshidi A. Primary spinal extradural Ewing's sarcoma (primitive neuroectodermal tumor): Report of a case and meta-analysis of the reported cases in the literature. Surg Neurol Int 2012; 3:55. [PMID: 22629492 PMCID: PMC3356992 DOI: 10.4103/2152-7806.96154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/22/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Primary spinal primitive neuroectodermal tumors (PNET) and/or spinal extraskeletal Ewing's sarcoma family tumors (ESET) are rare lesions appearing in the spinal extradural space. One hundred forty-one primary spinal PNETs, including 29 intramedullary lesions, have been reported in the literature. Encountering a case of primary epidural EES/peripheral PNET (pPNET) in sacral level, which is the fifth one occurring at this level in the literature, we have tried to conduct a meta-analysis of the reported cases. Case Description: A 44-year-old lady with epidural EES/pPNET is reported here. She was once operated for L5/S1 herniated disc, which did not ameliorate her symptoms. The clinical, imaging, surgical, and histopathologic characteristics of our case are presented and wide search of the literature is also done. All the reports were level 3 or less evidences and most of the series had missing parts. 106 cases of primary intraspinal (extradural/extramedullary-intradural) EES/pPNET and 29 cases of primary intramedullary PNET (CNS-PNET) have been reported in the literature. The most common clinical presentation in both entities was muscle weakness proportionate to the tumor location. Distant metastasis occurred in 38 of 99 (38%) cases of primary intraspinal EES/pPNET, while the rate of metastasis was 48% in patients with PNETs occurring in the intramedullary region (P > 0.05). One-year survival rate of the patients who underwent chemo-radiation after total or subtotal resection was better than those who did not receive chemotherapy or radiotherapy, or did not have total or subtotal resection. However, this difference was not repeated in 2-year survival rate in any of the tumor groups. Conclusion: It seems that total or subtotal removal of the tumor and adjuvant chemo- and radiation therapy can improve the outcome in these patients.
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Affiliation(s)
- Saeed Saeedinia
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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20
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Abstract
Spinal primitive neuroectodermal tumor (PNET) is rare. We present clinical, radiologic profile and treatment outcome of 15 spinal PNET patients from June 2003 to March 2010 treated with chemoradiotherapy. Median duration of backache was 6.5 months; all had features of myelopathy and/or radiculopathy; 5/15 (33.3%) patients were diagnosed initially as spinal tuberculosis. The event-free survival (EFS) was 24.73% at a median follow-up of 22 months. Complete functional recovery to treatment significantly predicted better EFS; 4 patients discontinued treatment because of poor functional recovery. It is important to recognize spinal PNET early to prevent permanent neurological damage, which in turn would improve compliance, quality of life, and perhaps EFS.
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21
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Coumans JVC, Walcott BP, Nahed BV, Oh KS, Chi AS. Multimodal Therapy of an Intramedullary Cervical Primitive Neuroectodermal Tumor in an Adult. J Clin Oncol 2012; 30:e15-8. [DOI: 10.1200/jco.2011.38.6474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Brian P. Walcott
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Brian V. Nahed
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kevin S. Oh
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew S. Chi
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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22
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Radiologic-Pathologic Correlation of Pediatric and Adolescent Spinal Neoplasms: Part 1, Intramedullary Spinal Neoplasms. AJR Am J Roentgenol 2012; 198:34-43. [DOI: 10.2214/ajr.10.7311] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Mulholland CB, Barkhoudarian G, Cornford ME, McBride DQ. Intraspinal primitive neuroectodermal tumor in a man with neurofibromatosis type 1: Case report and review of the literature. Surg Neurol Int 2011; 2:155. [PMID: 22140640 PMCID: PMC3228383 DOI: 10.4103/2152-7806.86835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 08/18/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The occurrence of primitive neuroectodermal tumors (PNET) in patients with neurofibromatosis type 1 (NF1) has only been reported in two other cases in English-Language literature. Owing to the rarity of intraspinal PNET and the extremely high gene mutation variability in NF1, there is currently no conclusive evidence to suggest that PNET is associated with NF1. Here, we report a case of intradural PNET in a patient with NF1. CASE DESCRIPTION A 27-year-old male underwent a C1-C3 laminectomy for resection of an intramedullary mass. Histopathology and immunohistopathology analysis was performed. Microscopic examination and immunohistochemical staining indicated the mass was a primitive neuroectodermal tumor. Within 1 month after tumor resection, the patient developed leptomeningeal carcinomatosis. The patient was not a candidate for radiation therapy but underwent palliative systemic chemotherapy. He subsequently developed neutropenia and died 3 months after tumor resection. CONCLUSION To our knowledge, this is the first reported intraspinal PNET associated with NF1. Genetic analysis of CNS PNETs suggests a possible correlation, but larger case series are needed to support this theory.
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Abstract
The authors present a case of extensive primary intramedullary spinal CNS ganglioneuroblastoma (GNB) in a 23-year-old man. Central nervous system GNB is a poorly differentiated neuroepithelial tumor composed of neuroblasts and differentiated ganglion cells, and these lesions are extremely uncommon. Most previously reported primary intraaxial neuroblastic tumors were described in the brain. There has been only one other report of primary spinal cord CNS GNB published to date; the clinical course and prognosis for primary spinal cord tumors of this type are unknown. Similar tumor types demonstrate poor prognoses.
This 23-year-old man presented after 9 months of progressive myelopathy. Admission MR imaging showed an intraaxial enhancing mass extending from C-3 to the conus medullaris, with a holocord appearance in several areas. Due to the tumor size, operative intervention was initially limited to biopsy sampling. Chemotherapy resulted in histological maturation, but initial tumor regression was temporary. The patient suffered progressive quadriparesis, and neuroimaging demonstrated slow enlargement of the tumor and an associated syrinx. Nineteen months after diagnosis, the tumor was excised to gross-total resection in a 2-stage operation. One year following resection, the patient had no radiographic recurrence and was functional in a wheelchair with minimal paresis in the upper extremities. This case represents the most extensive example of primary spinal intramedullary CNS GNB reported to date. Holocord tumors present a significant challenge to the neurosurgeon, and resection bears substantial risk of morbidity. In spinal cord CNS GNB, chemotherapy followed by complete resection may be the most effective means of tumor control.
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Affiliation(s)
- William R Miele
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
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25
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Yan Y, Xu T, Chen J, Hu G, Lu Y. Intraspinal Ewing's sarcoma/primitive neuroectodermal tumors. J Clin Neurosci 2011; 18:601-6. [PMID: 21414790 DOI: 10.1016/j.jocn.2010.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
Intraspinal Ewing's sarcoma (ES) and primitive neuroectodermal tumors (PNET) are very rare, and the characteristics and prognoses of the disease remain unclear. We present an illustrative patient with an intradural, extramedullary PNET arising within the cervical spinal canal, with clinical and radiological manifestations of leptomeningeal spread, and review the reports of a further 77 patients with intraspinal ES/PNET. Cox regression analyses showed that tumor location (extradural, intradural) (p=0.002, RR=4.217, 95% confidence interval [CI] 1.668-10.664) and spinal segment location (cervical, thoracic, lumbar, or sacral) (p=0.017, RR=2.040, 95% CI 1.133-3.673) were independent factors in the prognosis of intraspinal ES/PNET. We concluded that a peripheral PNET may originate within the spinal canal and exhibit leptomeningeal spread similar to that seen in central PNET, and that a patient with an intradural ES/PNET high in the spinal canal is more likely to have a poor prognosis.
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Affiliation(s)
- Yong Yan
- Department of Neurosurgery, Changzheng Hospital, Neurosurgery Research Institution of Shanghai, 415 Fengyang Street, Huangpu District, Shanghai 200003, China
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26
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Shimosawa H, Matsumoto M, Yabe H, Mukai M, Toyama Y, Morioka H. Primary primitive neuroectodermal tumor of the conus medullaris in an elderly patient: a case report and review of the literature. Case Rep Oncol 2011; 4:267-74. [PMID: 21734881 PMCID: PMC3124460 DOI: 10.1159/000323263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are very rare conditions. Most of these tumors occur in children and young adults. A 63-year-old man with a primary spinal PNET in the conus medullaris from the L1 to L2 level is presented in this report. The optimal treatment of primary spinal PNETs is yet unknown. Surgical resection, radiation therapy, and chemotherapy have been advocated for the treatment of spinal PNET based on PNETs at other sites. However, the outcome is very poor. There are a few reports of cases with long-term survival and no recurrence. In these patients, en bloc resections were performed.
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Affiliation(s)
- H Shimosawa
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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27
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Ellis JA, Rothrock RJ, Moise G, McCormick PC, Tanji K, Canoll P, Kaiser MG, McCormick PC. Primitive neuroectodermal tumors of the spine: a comprehensive review with illustrative clinical cases. Neurosurg Focus 2011; 30:E1. [PMID: 21194274 DOI: 10.3171/2010.10.focus10217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are uncommon malignancies that are increasingly reported in the literature. Spinal PNETs, like their cranial counterparts, are aggressive tumors and patients with these tumors typically have short survival times despite maximal surgery, chemotherapy, and radiation. Because no standard management guidelines exist for treating these tumors, a multitude of therapeutic strategies have been employed with varying success. In this study the authors perform a comprehensive review of the literature on primary spinal PNETs and provide 2 new cases that highlight the salient features of their clinical management.
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Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
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28
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FUJISAWA H, KANEKO T, TOHMA Y, KIDA S, KAIZAKI Y. Central Nervous System Primitive Neuroectodermal Tumor of Spinal Cord Developing 20 Years After Curative Treatment of Pineal Tumor -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:596-9. [DOI: 10.2176/nmc.51.596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Takuro KANEKO
- Department of Neurosurgery, Fukui Prefectural Hospital
| | - Yasuo TOHMA
- Department of Neurosurgery, Fukui Prefectural Hospital
| | - Shinya KIDA
- Department of Neurosurgery, Fukui Prefectural Hospital
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29
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Dhatt S, Dhillon MS, Tripathy SK, Goyal T, Jagadeesh V. Peripheral primitive neuroectodermal tumor causing cauda equina syndrome with destruction of L5 vertebra. Indian J Orthop 2010; 44:339-41. [PMID: 20697491 PMCID: PMC2911938 DOI: 10.4103/0019-5413.65153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 24-year-old male patient presented with cauda equina lesion symptoms. His clinicoradiological examination including X-rays, CT scan and MRI revealed destruction of L(5) vertebral body, pedicle and a mass extending to lateral recess and left intervertebral foramina causing pressure over the thecal sac. A CT guided FNAC was inconclusive. Open biopsy and hemilaminectomy of L(5) vertebra was performed. Histopathology and immunocytochemical analysis revealed it to be primitive neuroectodermal tumor. Patient was given chemotherapy and radiation therapy. His lower limb power improved by grade I post operatively and at 2 years follow-up bowel/bladder recovery was noticed. Patient died after 2.5 years of surgery because of pulmonary metastasis.
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Affiliation(s)
- Sarvdeep Dhatt
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India
- Address for correspondence: Dr. Sarvdeep Dhatt, Department of Orthopedics, PGIMER, Sector-12, Chandigarh-160 012, India. E-mail:
| | - Mandeep S Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India
| | - Sujit K Tripathy
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - V Jagadeesh
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India
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30
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Kiatsoontorn K, Takami T, Ichinose T, Chokyu I, Tsuyuguchi N, Ohsawa M, Ohata K. Primary epidural peripheral primitive neuroectodermal tumor of the thoracic spine. Neurol Med Chir (Tokyo) 2010; 49:542-5. [PMID: 19940407 DOI: 10.2176/nmc.49.542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 25-year-old male patient presented with an extremely rare primary spinal peripheral primitive neuroectodermal tumor (pPNET) manifesting as acutely progressive paraparesis and back pain. Neuroimaging and intraoperative examination showed that the tumor was confined to the epidural space of the thoracic spine. The patient was treated successfully by gross total resection of the tumor followed by chemotherapy and local radiotherapy. The present case illustrates the unexpected occurrence and important differential diagnosis of primary epidural pPNET of the thoracic spine in young patients presenting with progressive paraparesis and back pain.
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31
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Alexander HS, Koleda C, Hunn MK. Peripheral Primitive Neuroectodermal Tumour (pPNET) in the cervical spine. J Clin Neurosci 2009; 17:259-61. [PMID: 20036553 DOI: 10.1016/j.jocn.2009.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/06/2009] [Indexed: 11/18/2022]
Abstract
Primary spinal primitive neuroectodermal tumours are rare. We present a 45-year-old man with a peripheral primitive neuroectodermal tumour arising in the cervical spine. We believe this to be the first report of this type of tumour in the cervical spine.
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MESH Headings
- Anti-Inflammatory Agents/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Cervical Vertebrae/pathology
- Cervical Vertebrae/surgery
- Decompression, Surgical
- Dura Mater/pathology
- Dura Mater/surgery
- Gadolinium
- Humans
- Laminectomy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoplasm Recurrence, Local/complications
- Neoplasm Recurrence, Local/radiotherapy
- Neuroectodermal Tumors, Primitive, Peripheral/complications
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/physiopathology
- Neurosurgical Procedures
- Palliative Care
- Peripheral Nervous System Neoplasms/complications
- Peripheral Nervous System Neoplasms/pathology
- Peripheral Nervous System Neoplasms/physiopathology
- Prognosis
- Quadriplegia/etiology
- Spinal Canal/pathology
- Spinal Canal/surgery
- Spinal Cord/pathology
- Spinal Cord/physiopathology
- Spinal Cord/surgery
- Spinal Cord Compression/etiology
- Spinal Cord Compression/pathology
- Spinal Cord Compression/physiopathology
- Spinal Nerve Roots/pathology
- Spinal Nerve Roots/physiopathology
- Spinal Nerve Roots/surgery
- Steroids/therapeutic use
- Subdural Space/pathology
- Subdural Space/surgery
- Survival Rate/trends
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Affiliation(s)
- H S Alexander
- Capital and Coast District Health Board, Newtown, Wellington 6021, New Zealand.
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32
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Otero-Rodríguez A, Hinojosa J, Esparza J, Muñoz MJ, Iglesias S, Rodríguez-Gil Y, Ricoy JR. Purely intramedullary spinal cord primitive neuroectodermal tumor: case report and review of the literature. Neurocirugia (Astur) 2009; 20:381-6; discussion 386-7. [PMID: 19688140 DOI: 10.1016/s1130-1473(09)70159-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Primitive neuroectodermal tumors (PNETs) are malign neoplasms of the central nervous system which mainly locate in cerebellum (medulloblastoma). Primary intraspinal PNETs are rare. Within this group, we have found ten cases of purely intramedullary PNETs (IPNETs). In this report, we describe a new IPNET case and review the literature about these infrequent intramedullary tumors. CASE REPORT A 17 month-old boy showed progressive decrease of motion in his lower extremities. Spine magnetic resonance imaging revealed an intramedullary expansive lesion from T3 to T10. A near-total removal was performed. The pathological diagnosis was PNET. Subsequent chemotherapy was recommended. Six months after operation, holocord progression has occurred. CONCLUSION IPNETs are uncommon tumors affecting children and young adults. They are characterized by recurrence, progression or intracranial dissemination. Outcome is dismal: most patients die within two years in spite of surgical resection followed by radiotherapy and chemotherapy.
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Affiliation(s)
- A Otero-Rodríguez
- Division of Pediatric Neurosurgery, "12 de Octubre" Hospital, Madrid
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33
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Hrabálek L, Kalita O, Svebisova H, Ehrmann J, Hajduch M, Trojanec R, Kala M. Dumbbell-shaped peripheral primitive neuroectodermal tumor of the spine--case report and review of the literature. J Neurooncol 2008; 92:211-7. [PMID: 19050994 DOI: 10.1007/s11060-008-9744-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare. Here, we present a case study of a 29-year-old male with a dumbbell-shaped pPNET at the T9-10 spine level, including details of his examination, surgical procedures applied, histological and genetic findings, and his subsequent treatment. We discuss the clinical course, the pathology and treatment for this disease, the surgical approach to thoracic dumbbell tumors and we review the literature. To our knowledge, this is the first report of a case of a dumbbell-shaped intradural and spinal peripheral PNET.
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34
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Musahl V, Rihn JA, Fumich FE, Kang JD. Sacral intraspinal extradural primitive neuroectodermal tumor. Spine J 2008; 8:1024-9. [PMID: 17981095 DOI: 10.1016/j.spinee.2007.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Revised: 09/25/2006] [Accepted: 04/08/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intraspinal primitive neuroectodermal tumors (PNETs) are an exceedingly rare entity. A recent literature research revealed 28 cases reported. Only a few tumors in the literature were extradural in location, in the cervical and thoracic spine. The average survival after combination treatment including chemotherapy, radiation, and surgical resection is 20 months for the cases reported in the literature. PURPOSE We report a case of a patient with sciatica and cauda equine-like symptoms. STUDY DESIGN Case report. METHODS Urgent sacral decompression and resection of the tumor was performed with rapid pain relief for the patient. RESULTS Histology revealed a sacral extradural small blue-cell tumor, consistent with ES/PNET family tumors. An oncological workup revealed that the tumor presentation was metastatic with pulmonary and abdominal nodules. The patient underwent combination chemotherapy with vincristine, doxorubicin, and cyclophosphamide with mesna for 4 months. CONCLUSIONS The patient was without disease after excision, two courses of 4-month chemotherapy, and one course of 5-week radiation to the sacrum at 2 years.
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Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, Division of Spinal Surgery, University of Pittsburgh Medical Center, Liliane Kaufmann Building, 3471 Fifth Avenue, Suite 1010, Pittsburgh, Pennsylvania 15213, USA
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35
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Ozdemir N, Usta G, Minoglu M, Erbay AM, Bezircioglu H, Tunakan M. Primary primitive neuroectodermal tumor of the lumbar extradural space. J Neurosurg Pediatr 2008; 2:215-21. [PMID: 18759606 DOI: 10.3171/ped/2008/2/9/215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) of the extradural space are very rare; only 10 cases have been reported in the English language literature. The histopathological diagnosis of primary spinal PNETs has been discussed for many years. These tumors have a rapidly progressive course, and there is no current consensus on the optimal therapeutic approach for these patients. The authors present a case of primary PNET located in the lumbar extradural space in a 13-year-old girl and report the clinical, radiological, histopathological, and surgical findings. They compare their findings with those from the other 10 cases reported in the literature and review relevant literature.
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Affiliation(s)
- Nail Ozdemir
- Department of Neurosurgery, Izmir Ataturk Training and Research Hospital, Narlidere-Izmir, Turkey.
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36
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Feng JF, Liang YM, Bao YH, Pan YH, Jiang JY. Multiple primary primitive neuroectodermal tumours within the spinal epidural space with non-concurrent onset. J Int Med Res 2008; 36:366-70. [PMID: 18380950 DOI: 10.1177/147323000803600222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A case of multiple primary primitive neuroectodermal tumours (PNETs), which occurred at different levels of the spinal epidural space successively over a period of 8 months, is reported. A 24-year-old male, presenting with rapidly progressive paralysis, hyperthesia and a posterior epidural mass extending from T8 to T10 revealed by magnetic resonance imaging (MRI), exhibited a good recovery after initial emergency surgery. Lower back pain, chest pain and paralysis were subsequently reported. Spinal MRI in month 7 revealed a mass extending from T12 to L1 and another mass extending from T4 to T5 was detected epidurally in month 8. Additional operations were performed and radiotherapy was given. Pathological findings were consistent with PNETs and symptoms improved with treatment, particularly following each surgical excision.
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Affiliation(s)
- J F Feng
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University/School of Medicine, Shanghai, People's Republic of China
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37
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Tiago RSL, Pio MRB, Silva MN, do Valle LO. Peripheral primitive neuroectodermal tumor: a rare case of peripheral facial paralysis. Braz J Otorhinolaryngol 2007; 73:136. [PMID: 17505616 PMCID: PMC9443565 DOI: 10.1016/s1808-8694(15)31139-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 07/27/2006] [Indexed: 11/21/2022] Open
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Abstract
In children, tumors of the spine are much rarer than intracranial tumors. They are classified into intramedullary, intradural-extramedullary, and extradural tumors. Magnetic resonance imaging provides crucial information regarding the extent, location, and internal structure of the mass, thus critically narrowing the differential diagnosis and guiding surgery.
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Affiliation(s)
- Andrea Rossi
- Department of Pediatric Neuroradiology, G. Gaslini Children's Hospital, Largo G. Gaslini 5, I-16147 Genoa, Italy.
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Perry R, Gonzales I, Finlay J, Zacharoulis S. Primary peripheral primitive neuroectodermal tumors of the spinal cord: report of two cases and review of the literature. J Neurooncol 2007; 81:259-64. [PMID: 17203398 DOI: 10.1007/s11060-006-9178-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 04/10/2006] [Indexed: 10/23/2022]
Abstract
Primary intraspinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare tumors with only seven reported cases in the literature. The histopathologic diagnosis of this tumor is complex and has led to a variety of treatment approaches. The distinction between central and peripheral type primary spinal cord PNETs has not always been made in the literature, leading to a paucity of data in this disease. We present here two young patients with primary intraspinal pPNET, their treatment and outcome. The first patient, a 27 year old male, presented with an intradural mass extending from L2 through L5, after multiple relapses, he is currently alive with disease after 72 months, the longest survival yet reported. The second patient, a 16 year old female, presented with an intradural mass at the cauda equina from L2 through L5, and is currently alive with responsive disease at 5 months after initial diagnosis. Here, we discuss the clinical course, the pathology and treatment for this disease and review the literature.
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Affiliation(s)
- R Perry
- Department of Pediatric Hematology/Oncology Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, 4650 Sunset #54, Los Angeles, CA, 90027, USA.
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41
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Nutman A, Postovsky S, Zaidman I, Elhasid R, Vlodavsky E, Kreiss Y, Ben Arush MW. Primary intraspinal primitive neuroectodermal tumor treated with autologous stem cell transplantation: case report and review of the literature. Pediatr Hematol Oncol 2007; 24:53-61. [PMID: 17130114 DOI: 10.1080/08880010601001396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The authors describe the case of a 19-year-old female patient with a primary primitive neuroectodermal tumor (PNET) of the thoraco-lumbar spinal cord, who presented with acute urinary retention and back pain for 2 months. Magnetic resonance imaging revealed an intradural extramedullary tumor, 6.5 cm long, in the region of the conus medullaris. Histological examination disclosed a small round cell tumor with immunohistochemical characteristics of a peripheral PNET. Metastatic workup showed no evidence of an intracranial tumor or metastases outside the neuroaxis. The patient received multidisciplinary treatment, including surgical excision, irradiation of the entire cranio-spinal axis, and high-dose chemotherapy with autologous stem cell rescue. Presently, 24 months after diagnosis, the patient remains in complete remission.
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Affiliation(s)
- Amir Nutman
- Israel Defense Forces, Medical Corps, Haifa, Israel
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42
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Kumar R, Reddy SJ, Wani AA, Pal L. Primary spinal primitive neuroectodermal tumor: case series and review of the literature. Pediatr Neurosurg 2007; 43:1-6. [PMID: 17190980 DOI: 10.1159/000097517] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 05/04/2006] [Indexed: 11/19/2022]
Abstract
Primary spinal primitive neuroectodermal tumor (PSPNET) is extremely rare and only 25 cases have been reported in the world literature so far. Three patients of 8, 9 and 18 years of age, who presented with variable grades of neurological deficit were diagnosed as having a dorsal intramedullary lesion, a holocord lesion and cervical extradural tumor with extraspinal extension, respectively, and were operated at our institute. The histopathology of all 3 children revealed PNET. The clinical course, image characteristics and outcome of the 3 children are described, and the relevant literature is reviewed. The following conclusions were drawn from the present study and review of the literature. PNET may manifest itself as a primary lesion of the spine unlike the more common drop metastases from an intracranial lesion. PSPNET may be intramedullary, intradural and extradural with variable extraspinal extension. PSPNET may present as holocord intramedullary lesion, an entity which has not been described earlier. These lesions have a short history, significant neurological deficits and rapid course of illness. PSPNET, though an established entity, did not find a place in the WHO 2000 classification of CNS tumors. Hence its status has to be defined.
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Affiliation(s)
- Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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43
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Berrocal A, Montgomery DL, Mackie JT, Storts RW. Primitive neuroectodermal tumor in the spinal cord of a brahman crossbred calf. Vet Pathol 2006; 42:834-6. [PMID: 16301582 DOI: 10.1354/vp.42-6-834] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A variety of embryonal tumors of the central nervous system, typically malignant and occurring in young individuals, are recognized in humans and animals. This report describes an invasive subdural but predominantly extramedullary primitive neuroectodermal tumor developing at the lumbosacral junction in a 6-month-old Brahman crossbred calf. The tumor was composed of spindloid embryonal cells organized in interlacing fascicles. The cells had oval to elongate or round hyperchromic nuclei, single to double nucleoli, and scant discernible cytoplasm. Immunohistochemical staining for neuron-specific enolase, synaptophysin, and S-100 protein and formation of pseudorosettes suggested neuronal and possibly ependymal differentiation.
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Affiliation(s)
- A Berrocal
- Dept. of Veterinary, Laramie, WY 82070, USA
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44
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Jain A, Jalali R, Nadkarni TD, Sharma S. Primary intramedullary primitive neuroectodermal tumor of the cervical spinal cord. Case report. J Neurosurg Spine 2006; 4:497-502. [PMID: 16776362 DOI: 10.3171/spi.2006.4.6.497] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary intramedullary primitive neuroectodermal tumors (PNETs) of the spinal cord are rare. Only six cases have previously been reported, all involving tumors in the thoracic or lumbar spine. The authors report the case of a 54-year-old woman who presented with quadriplegia and bladder and bowel dysfunction. The patient had suffered symptoms of neck pain for 1 month and left shoulder weakness for 10 days. Magnetic resonance imaging of the cervical spine revealed an intramedullary mass extending from C-2 to C-5 with an exophytic component in the adjacent left subarachnoid space. Multiple biopsy specimens were obtained, and a partial excision was performed. Histological examination revealed nodular growth and neuronal differentiation, with a striking resemblance to desmoplastic medulloblastoma. A positron emission tomography scan did not reveal uptake at any site. These findings confirmed the diagnosis of a primary intramedullary PNET. Postoperatively, the patient was given craniospinal radiotherapy with a radiation boost to the tumor bed.
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Affiliation(s)
- Amit Jain
- Department of Radiation Oncology and Pathology, Tata Memorial Hospital, King Edward Memorial Hospital, Mumbai, India
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45
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De Tommasi A, De Tommasi C, Occhiogrosso G, Cimmino A, Parisi M, Sanguedolce F, Ciappetta P. Primary intramedullary primitive neuroectodermal tumor (PNET)--case report and review of the literature. Eur J Neurol 2006; 13:240-3. [PMID: 16618339 DOI: 10.1111/j.1468-1331.2006.01183.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Spinal primitive neuroectodermal tumors (PNET) are very rare tumors, and intramedullary localization is even less common. Indeed, amongst the 23 cases of the spinal PNET described in the literature, only eight cases had an intramedullary localization. Following the WHO 2000 classification, PNETs have been considered embryonal tumors composed of undifferentiated neuroepithelial cells with a capacity of differentiation into different cellular lines, such as astrocytic, ependymal, melanotic and muscular. They have been considered to arise from a neoplastic transformation of primitive neuroepithelial cells, thereby making their presence possible in any part of the central nervous system. The optimal treatment for these malignant tumors is not yet clear, although, over the years, radiotherapy has been considered the best treatment for spinal PNETs. The described case is that of a 38-year-old man with a primary intra-extramedullary PNET, treated by laminectomy, open biopsy and chemotherapy. The patient, 18 months after the onset of his symptomatology, died without cerebral tumor involvement.
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Affiliation(s)
- A De Tommasi
- Department of Neurosurgery, University of Bari, Italy.
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46
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Bohn Sarmiento U, Aguiar Bujanda D, Camacho Galán R, Rivero Vera JC, Aguiar Morales J. Lumbar region intra-spinal primitive neuroectodermal tumour (PNET) combined with neurofibromatosis type 1. Clin Transl Oncol 2006; 7:464-7. [PMID: 16373056 DOI: 10.1007/bf02716598] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primitive neuroectodermal tumours (PNET) are aggressive neoplasias that are diagnosed, usually, in infancy. Their appearance in adulthood is rare and, exceptionally, in association with neurofibromatosis type I (NF-1). We present a case of a 37 year-old man with NF-1 combined with PNET in the intra-arachidial lumbar region. Diagnosis was by Nuclear Magnetic Resonance (NMR) and biopsy of soft tissue mass which showed a PNET with undifferentiated round cells and immunohistochemically positive for CD99, neurone-specific enolase, synaptophys in and LEU-7. Surgery was performed with spine decompression and resection of 80% of the tumour, with symptoms improvement. Radiotherapy was administered on the lumbosacral column, but only up to 30 Gy because of severe actinic enteritis and pan-cytopenia grade III. Six months later, the patient was hospitalized with deterioration in his overall clinical status with multi-organ involvement. The patient died and an autopsy was performed. The initial treatment of the PNET is surgery and, if possible, the radical extirpation of the tumour. Administration of radiotherapy and chemotherapy appears to increase survival. We comment on the clinical, histological, cytological and immunohistochemical aspects together with a review of the literature. To the best of our knowledge this is the first documentation of such a case.
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Affiliation(s)
- Uriel Bohn Sarmiento
- Servicio de Oncología Médica, Hospital General Universitario de Gran Canaria Dr. Negrín. Las Palmas de Gran Canaria, España.
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Krampulz T, Hans VH, Oppel F, Dietrich U, Puchner MJA. Long-term relapse-free survival with supratentorial primitive neuroectodermal tumor in an adult: a case report. J Neurooncol 2006; 77:291-4. [PMID: 16528456 DOI: 10.1007/s11060-005-9041-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 09/07/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In adults, supratentorial primitive neuroectodermal tumor (sPNET) is a very rare undifferentiated embryoblastic neoplasm. Prognosis is worse in comparison to infratentorial medulloblastoma. Older age appears to be prognostically favorable. At present, 5-year survival rates remain below 50% in all age groups. Survival longer than 15 years in an adult has only been reported once so far. CASE REPORT In 1987, a 33-year-old-male patient presented with seizures following a six-month's history of dizziness. CT- and MRI-scans revealed a right occipital tumor with moderate contrast enhancement. The tumor was completely removed. The original histological diagnosis was that of an undifferentiated sarcoma, malignant hemangioendothelioma, grade III. The patient was treated by CyVADIC chemotherapy and conventional radiation therapy (60 Gy). Admission for another reason in 2003 led to a re-evaluation of the original diagnosis. Microscopy revealed a malignant, highly cellular, poorly differentiated tumor with a desmoplastic component. Up to 20% of tumor nuclei were labeled for Ki-67. Almost all cells were stained for neuron specific enolase and NGF-Rp75, with neuronal and glial markers being present to a variable extent. According to these findings, the diagnosis was changed to a sPNET (WHO IVdegrees ). Other tumor entities were excluded by immunohistochemistry. CONCLUSIONS Although the prognosis of sPNET is reported to be poor, a small fraction with a rather benign biological and clinical behavior exists. Parameters determining long-term-survival in sPNET are not yet known. Whenever possible, complete surgical resection should be attempted followed by postoperative radiotherapy. The value of chemotherapy is an issue of continuous investigation.
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Kampman WA, Kros JM, De Jong THR, Lequin MH. Primitive neuroectodermal tumours (PNETs) located in the spinal canal; the relevance of classification as central or peripheral PNET. J Neurooncol 2005; 77:65-72. [PMID: 16292490 DOI: 10.1007/s11060-005-9006-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Indexed: 10/25/2022]
Abstract
Intraspinal location of central PNET (cPNET) is very rare. We present a case, critically review all publications of primary intraspinal cPNET occurrence and discuss tendencies in clinical presentation. In several previous attempts to summarise, authors often confused cPNET with peripheral PNET (pPNET). cPNET and pPNET are different entities with different immunohistochemical profiles and genetic backgrounds. Clinically, they are both aggressive tumours, but exhibit different characteristics in their local manifestation and metastatic spread. Survival rates are quite similar provided that treatment is applied according to the established protocols. Protocols in cPNET treatment differ from those for pPNET as regards the order of the treatment sub-modalities, specific chemotherapeutic regimen and intensity, radiation dose and its extent and consequently, the side effects. Therefore, failure to distinguish cPNET from pPNET leads to clinical guidance and treatment proposals based on false assumptions, which might effect outcomes. Often, distinguishing between cPNET and pPNET is easy, because they occur in different location. In the case of intraspinal tumour location, however, the differentiation is crucial because both primary cPNET and pPNET can occur intraspinally, even though this is rare. Nowadays, demonstrating the expression of MIC2 glycoprotein by immunocytochemical staining (CD99) showing the specific EWS-FLI1 chimeric gene presence in pPNET, offers an easy way of making a differential diagnosis between cPNET and pPNET.
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MESH Headings
- 12E7 Antigen
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Cell Adhesion Molecules/metabolism
- Child, Preschool
- Diagnosis, Differential
- Fatal Outcome
- Humans
- Male
- Neuroectodermal Tumors, Primitive/classification
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/therapy
- Neuroectodermal Tumors, Primitive, Peripheral/classification
- Neuroectodermal Tumors, Primitive, Peripheral/diagnosis
- Neuroectodermal Tumors, Primitive, Peripheral/metabolism
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Oncogene Proteins, Fusion/metabolism
- Proto-Oncogene Protein c-fli-1/metabolism
- RNA-Binding Protein EWS
- Spinal Cord Neoplasms/classification
- Spinal Cord Neoplasms/diagnosis
- Spinal Cord Neoplasms/metabolism
- Spinal Cord Neoplasms/surgery
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Affiliation(s)
- W A Kampman
- Academic Hospital of the Vrije Universiteit Brussel (AZVUB), Brussels, Belgium.
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49
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Weber DC, Rutz HP, Lomax AJ, Schneider U, Lombriser N, Zenhausern R, Goitein G. First spinal axis segment irradiation with spot-scanning proton beam delivered in the treatment of a lumbar primitive neuroectodermal tumour. Case report and review of the literature. Clin Oncol (R Coll Radiol) 2004; 16:326-31. [PMID: 15341435 DOI: 10.1016/j.clon.2004.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary intraspinal primitive neuroectodermal tumour (PNET) is a rare tumour entity. The optimal therapeutic management is unclear but, in general, this tumour is treated with surgery followed by radiotherapy and chemotherapy. Proton beam radiation therapy (PT) offers superior dose distributional qualities compared with X- or gamma rays, as the dose deposition occurs in a modulated narrow zone called the Bragg peak. As a result, organs at risk are optimally speared. Here, we present a patient treated with the first spinal axis segment irradiation using spot-scanning PT with a single field, combined with conventional cranio-spinal axis radiotherapy after surgery and chemotherapy, and an extensive review of the literature outlining the clinical features and treatment modality of spinal PNET.
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Affiliation(s)
- D C Weber
- Division of Radiation Medicine, Proton Therapy Program, Paul Scherrer Institute, Villigen, Switzerland.
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