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Cochetti G, Paladini A, de Vermandois JAR, Fatigoni S, Zanelli M, Ascani S, Mearini E. Metastatic renal Ewing's sarcoma in adult woman: Case report and review of the literature. Open Med (Wars) 2021; 16:397-409. [PMID: 33748424 PMCID: PMC7957192 DOI: 10.1515/med-2021-0207] [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: 02/17/2020] [Revised: 11/22/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Primary renal extra-skeletal Ewing sarcoma is a rare neoplasm, often metastatic at diagnosis, and with a poor outcome. A multimodal approach is often the treatment of choice in this aggressive neoplasm. We present a case of primary renal extra-skeletal sarcoma in a 45-year-old woman who underwent tumor resection without clear margins. After no response to the first cycle of chemotherapy, we documented an early onset of local recurrence. The patient refused any other treatment and died four months after surgery.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Sonia Fatigoni
- Department of Surgical and Biomedical Sciences, Medical Oncology, University of Perugia, Perugia, Italy
| | - Magda Zanelli
- Department of Oncology and Advanced Technologies, Pathology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Department of Experimental Medicine, Institute of Pathologic Anatomy, “Santa Maria” Hospital, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
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Liang L, Song H, Ma B, Zhang Z, Zhu K, Li Q, Zhou C, Li A, Liu J, Zhang Q, Zhu S, Zhang Q. Renal Ewing's sarcoma/primitive neuroectodermal tumor (PNET): a case series of 7 patients and literature review. Transl Androl Urol 2021; 10:548-554. [PMID: 33718057 PMCID: PMC7947461 DOI: 10.21037/tau-20-1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Primitive neuroectodermal tumor (PNET) is a rare kind of sarcoma that is primarily found in the kidney and has a very poor prognosis. Here, we review and summarize the clinical data of patients with renal PNET in our center and follow up the patients for survival status. Although the current literature suggests that chemotherapy may benefit the survival of these patients, the information from our center suggests that this may not be the case. Methods We retrospectively analyzed the clinical data of patients with renal PNET diagnosed pathologically at Peking University First Hospital from January 1, 2007, to January 1, 2018. All of the patients were followed up for survival status. Results Seven patients with renal PNET were found. The ratio of males to females was 6:1. The median age was 29 years (21–72 years) at the time of diagnosis. The preoperative imaging examination showed a large renal mass protruding outwards from the renal contour, with internal necrosis and hemorrhage. Six/7 patients were diagnosed with distant metastasis or retroperitoneal lymph node metastasis. The main clinical manifestations of patients were pain (5/7) and fever (3/7). In immunohistochemistry, all patients’ samples were CD99 positive. All patients died in our follow-up, with an average overall survival (OS) of 12.09 months (1.90–26.77 months). Conclusions As a rare renal tumor, renal PNET has a propensity to occur in young males. Most patients have distant metastasis when they are diagnosed, and the prognosis is very poor. Effective treatments are urgently needed.
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Affiliation(s)
- Lei Liang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Haifeng Song
- Department of Urology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Binglei Ma
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhenan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kun Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Qinhan Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Chaohui Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Aolin Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jun Liu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Quan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shiyu Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
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Tripathy S, Shamim SA, Chellapuram S, Barwad A, Rastogi S. Primary Ewing Sarcoma/Primitive Neuroectodermal Tumor of Kidney With Inferior Vena Cava Thrombus: Findings on 18F-FDG PET/CT. Clin Nucl Med 2020; 45:e103-e105. [PMID: 31876802 DOI: 10.1097/rlu.0000000000002865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary Ewing sarcoma/primitive neuroectodermal tumor is a group of rare aggressive tumors in adults derived from neuroectoderm, and primary renal involvement is extremely rare. We describe an F-FDG PET/CT findings of a 28-year-old man who presented with left renal mass with inferior vena cava thrombus, which turned out to be primary Ewing sarcoma on histopathology specimen post left nephrectomy.
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Affiliation(s)
| | | | | | - Adarsh Barwad
- Pathology, All India Institute of Medical Sciences, New Delhi, India
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4
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Talwar A, Kishore M, Bhardwaj M, Chauhan DS. Primitive neuroectodermal tumor of the kidney: A rare case report. J Lab Physicians 2020; 10:351-353. [PMID: 30078975 PMCID: PMC6052811 DOI: 10.4103/jlp.jlp_42_18] [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] [Indexed: 11/26/2022] Open
Abstract
Renal primitive neuroectodermal tumor (PNET) is a rare primary renal neoplasm. Morphologically, it may mimic small blue round-cell tumor. Hence, histopathology in conjunction with immunohistochemistry plays a significant role in correctly diagnosing this malignancy. We report a case of PNET of kidney in a 30-year-old female with an extension to inferior vena cava, who succumbed following an aggressive course of illness.
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Affiliation(s)
- Amrita Talwar
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
| | - Manjari Kishore
- Department of Pathology, Dr. RML Hospital, PGIMER, New Delhi, India
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Primary renal Ewing's sarcoma in a young male treated completely by surgical excision without chemotherapeutic agents: Case report. Int J Surg Case Rep 2019; 63:122-124. [PMID: 31585322 PMCID: PMC6796631 DOI: 10.1016/j.ijscr.2019.09.016] [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: 07/26/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
Primary renal Ewing sarcoma is a rare tumor in adults. Proper surgical resection is the most important treatment step. Further studies needed to establish treatment for this tumor.
Introduction Primary renal Ewing’s sarcoma is a rare tumor with dismal prognosis. The main treatment modality of treatment is surgical excision with adjuvant or neoadjuvant chemotherapy. Case presentation We present a case of primary renal EWS in 27-year-old male. He presented to our center complaining of three days history of severe left flank pain associated with nausea and vomiting. Computerized tomography (CT) revealed a 10 × 7 × 6.5 cm left lower pole renal mass. Left radical nephrectomy was performed and revealed a tumor with uniform round to oval nuclei cells. The cells stained strongly positive for CD 99. The diagnosis was established as primary renal Ewing’s sarcoma. The patient refused the chemotherapy. Fortunately, he was free of the disease on regular clinical and radiological follow-up, the last follow up was 30 months post-nephrectomy. Conclusion This case highlights the importance of proper surgical treatment and its role in the managing this type of malignancy especially in localized disease at presentation.
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Kumar P, Singh A, Deshmukh A, Phulware RH, Rastogi S, Barwad A, Chandrashekhara SH, Singh V. Qualitative and quantitative CECT features for differentiating renal primitive neuroectodermal tumor from the renal cell carcinoma and its subtypes. Br J Radiol 2018; 92:20180738. [PMID: 30362816 DOI: 10.1259/bjr.20180738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE: To identify important qualitative and quantitative clinical and imaging features that could potentially differentiate renal primitiveneuroectodermal tumor (PNET) from various subtypes of renalcell carcinoma (RCC). METHODS: We retrospectively reviewed 164 patients, 143 with pathologically proven RCC and 21 with pathologically proven renal PNET. Univariate analysis of each parameter was performed. In order to differentiate renal PNET from RCC subtypes and overall RCC as a group, we generated ROC curves and determined cutoff values for mean attenuation of the lesion, mass to aorta attenuation ratio and mass to renal parenchyma attenuation ratio in the nephrographic phase. RESULTS: Univariate analysis revealed 11 significant parameters for differentiating renal PNET from clear cell RCC (age, p = <0.001; size, p =< 0.001; endophytic growth pattern, p < 0.001;margin of lesion, p =< 0.001; septa within the lesion, p =< 0.001; renal vein invasion, p =< 0.001; inferior vena cava involvement, p = 0.014; enhancement of lesion less than the renal parenchyma, p = 0.008; attenuation of the lesion, p = 0.002; mass to aorta attenuation ratio, p =< 0.001; and mass to renal parenchyma attenuation ratio, p =< 0.001). Univariate analysis also revealed seven significant parameters for differentiating renal PNET from papillary RCC. For differentiating renal PNET from overall RCCs as a group, when 77.3 Hounsfield unit was used as cutoff value in nephrographic phase, the sensitivity and specificity were 71.83 and 76.92 % respectively. For differentiating renal PNET from overall RCCs as a group, when 0.57 was used as cutoff for mass to aorta enhancement ratio in nephrographic phase, the sensitivity and specificity were 80.28 and 84.62 % respectively. CONCLUSION: Specific qualitative and quantitative features can potentially differentiate renal PNET from various subtypes of RCC. ADVANCES IN KNOWLEDGE: The study underscores the utility of combined demographic and CT findings to potentially differentiate renal PNET from the much commoner renal neoplasm, i.e. RCC. It has management implications as if RCC is suspected, surgeons proceed with resection without need for confirmatory biopsy. On the contrary, a suspected renal PNET should proceed with biopsy followed by chemoradiotherapy, thus obviating the unnecessary morbidity and mortality.
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Affiliation(s)
- Pawan Kumar
- 1 Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India
| | - Anuradha Singh
- 1 Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India
| | - Ashwin Deshmukh
- 1 Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India
| | - Ravi Hari Phulware
- 2 Department of Pathology, All India Institute of Medical Sciences , New Delhi , India
| | - Sameer Rastogi
- 3 Department of Medical Oncology, All India Institute of Medical Sciences , New Delhi , India
| | - Adarsh Barwad
- 2 Department of Pathology, All India Institute of Medical Sciences , New Delhi , India
| | - S H Chandrashekhara
- 1 Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi , India
| | - Vishwajeet Singh
- 4 Department of Biostatistics, All India Institute of Medical Sciences , New Delhi , India
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Garg G, Aeron R, Singh B, Agarwal S. Primitive neuroectodermal tumor of kidney mimicking as an inflammatory renal mass. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Unilateral Renal Primitive Neuroectodermal Tumor (PNET). INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.7409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jin X, Cao J, Liu Y, Bian F, Zhao Q, Wang Y, Lv X, Huang Y. Primitive neuroectodermal tumor originating from the lung: A case report. Oncol Lett 2016; 12:2692-2695. [PMID: 27698844 DOI: 10.3892/ol.2016.4973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/17/2016] [Indexed: 02/07/2023] Open
Abstract
Primitive neuroectodermal tumors (PNETs) are small, round cell tumors that may be classified as peripheral or central, based on their site of origin. PNETs often arise in the soft tissue or bone of young adults. Although not common, PNETs have been described in other organs, including the gonads, kidneys, myocardium and pancreas, but rarely in the lungs without chest wall or pleural involvement. The present study reports a rare case of peripheral PNET (pPNET), which originated in the lung. A 37-year-old female patient presented at Xuzhou Central Hospital (Xuzhou, China) with a history of a dry cough, mild dyspnea and slight pain in the left chest. Histopathological and immunohistochemical analyses permitted the diagnosis of a pPNET. The patient was treated with surgical resection, followed by chemotherapy (including cyclophosphamide, cisplatin and vincristine), radiotherapy and traditional Chinese medicine (including Kanglaite and Shenqi Fuzheng injections). At the time of writing, the patient was alive with no sign of recurrence and under regular follow-ups at the Outpatient Clinic of Xuzhou Central Hospital.
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Affiliation(s)
- Xin Jin
- Department of Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Jianfeng Cao
- Intensive Care Unit, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Yong Liu
- Department of Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Fang Bian
- Department of Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Qingqing Zhao
- Department of Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Yan Wang
- Department of Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Xu Lv
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Yayong Huang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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Celli R, Cai G. Ewing Sarcoma/Primitive Neuroectodermal Tumor of the Kidney: A Rare and Lethal Entity. Arch Pathol Lab Med 2016; 140:281-5. [PMID: 26927724 DOI: 10.5858/arpa.2014-0367-rs] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Ewing sarcoma/primitive neuroectodermal tumor represents a spectrum of undifferentiated tumors with similar biology that together represent the second most common sarcoma in the pediatric-young adult age range. Very rarely, this tumor presents as a primary neoplasm of the kidney. The clinical presentation of this tumor is not specific, and other renal tumors may present with a similar histologic appearance. Establishing the correct diagnosis is critical because renal Ewing sarcoma/primitive neuroectodermal tumor carries a strikingly dismal prognosis and thus dictates a specific treatment strategy. A low threshold for the use of ancillary molecular tests is recommended, particularly in diagnostically problematic cases. Important considerations with regards to morphology, immunohistochemistry, and molecular alterations will be reviewed here and should be taken into account before rendering this rare and lethal diagnosis.
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Affiliation(s)
- Romulo Celli
- From the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Yang C, Xu H, Zhou J, Hao Z, Wang J, Lin C, Zhang L, Zhu X, Liang C. Renal Primitive Neuroectodermal Tumor: A Case Report. Medicine (Baltimore) 2015; 94:e2304. [PMID: 26656379 PMCID: PMC5008524 DOI: 10.1097/md.0000000000002304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Primitive neuroectodermal tumor (PNET) is a malignant small round cell tumor and typically arises from bone or soft tissue in adolescents and young adults. Renal PNET is extraordinarily rare and exhibits highly aggressive biological behavior with poor prognosis.We present here a new case of renal PNET in a 31-year-old female. The patients were referred to our hospital because of left flank pain with nausea and vomiting for 1 week. A computed tomography scan revealed a 14.7 × 12.7 cm well-defined, unevenly mass lesion with both solid and cystic components and the tumor was not enhanced uniformly.A preoperative diagnosis of cystic renal cell carcinoma and urinary tract infection was made. The patient undergone anti-inflammatory therapy followed by a left radical nephrectomy. Taken with morphological pattern and immunohistochemical markers, a diagnosis of renal PNET was made. Two cycles of combined chemotherapy were executed. At the 14-month follow-up, no evidence of metastasis or recurrence was indicated.This case reminds clinicians that for adolescents and young adults with a suspicious renal mass, a diagnosis of renal PNET should be always considered. An initial surgery followed by radiotherapy and chemotherapy is suggested for the therapeutic management.
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Affiliation(s)
- Cheng Yang
- From the Department of Urology (CY, HX, JZ, ZH, JW, LZ, CL), The First Affiliated Hospital of Anhui Medical University, Hefei; Department of Urology (CL), The Central Hospital of Maanshan, The Affiliated Hospital of Wannan Medical College, Maanshan; and Department of Pathology (XZ), The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Shi L, Guo Z, Wu X. Primary pulmonary primitive neuroectodermal tumor metastasis to the pancreas: a rare case with seven-year follow-up. Diagn Pathol 2013; 8:51. [PMID: 23537038 PMCID: PMC3621407 DOI: 10.1186/1746-1596-8-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/16/2013] [Indexed: 01/11/2023] Open
Abstract
Abstract There are only nine primitive neuroectodermal tumor (PNET) cases that have arisen in lung parenchyma without pleural or chest wall involvement in the literature. Here, we present a long–term survival case of pulmonary PNET. A pulmonary mass was detected in a 19-year-old man on a chest radiograph and computed tomography image. At the three-year follow-up, the mass had enlarged in diameter by two-fold. The lesion was resected via lower left lobectomy. Histologically, the tumor was composed of uniform cells with round nuclei and scanty cytoplasm arranged in lobules with rosettes and pseudorosettes formation. Immunohistochemically, the tumor was positive for CD99, vimentin, neuron specific enolase and chromogranin A, and negative for cytokeratins, CD3, desmin, and leukocyte common antigen. Pancreatic metastasis occurred sixteen months after the first surgery, which was managed by pancreatectomy. The patient has survived seven years after the mass was initially detected, and four years after the first lobectomy. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1500847644913244
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Affiliation(s)
- Lin Shi
- Department of Cardiovascular and Thoracic Surgery, The First Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia, P R China
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Xu N, Jin MS, Chen L, Wang CX, Sun ST, Shi AP. Renal primitive malignant tumor with endocrine activity. Med Princ Pract 2013; 22:200-3. [PMID: 22964717 PMCID: PMC5586721 DOI: 10.1159/000342194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 07/22/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a hypertensive and systematically pigmented female with primitive neuroectodermal tumors. CLINICAL PRESENTATION AND INTERVENTION A female patient presented with a complaint of right flank pain. She had a right renal space-occupying lesion, underwent right radical nephrectomy, and returned to normotensive postoperatively. The pathological examination identified typical primitive neuroectodermal tumor histology. During a 60-month follow-up period, she remained normotensive and demonstrated normal renal and adrenal functions. CONCLUSION Early diagnosis and definitive surgery led to the patient's long-term survival.
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Affiliation(s)
- Ning Xu
- Department of Urology, Jilin University First Hospital, Changchun, China
| | - Mei-Shan Jin
- Department of Pathology, Jilin University First Hospital, Changchun, China
| | - Liang Chen
- Department of Radiology, Jilin University First Hospital, Changchun, China
| | - Chun-Xi Wang
- Department of Urology, Jilin University First Hospital, Changchun, China
| | - Shou-Tian Sun
- Department of Urology, Jilin University First Hospital, Changchun, China
| | - Ai-Ping Shi
- Department of General Surgery, Jilin University First Hospital, Changchun, China
- *Dr. Ai-Ping Shi, Department of General Surgery, Jilin University First Hospital, 71 Xinmin Blvd, Changchun 130021 (China), Tel. +86 431 8878 2284, E-Mail
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Richey SL, Rao P, Wood CG, Patel S, Tannir NM. Metastatic extraosseous Ewing's sarcoma (EES)/primitive neuroectodermal tumor (PNET) of the kidney: 8-year durable response after induction and maintenance chemotherapy. Clin Genitourin Cancer 2012; 10:210-2. [PMID: 22503609 DOI: 10.1016/j.clgc.2012.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/07/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Stephen L Richey
- University of Texas M.D. Anderson Cancer Center, Genitourinary Medical Oncology, Houston, TX 77030, USA
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Primary Ewing’s sarcoma/primitive neuroectodermal tumor of the kidney that responded to low-dose chemotherapy with ifosfamide, etoposide, and doxorubicin. Int J Clin Oncol 2010; 15:210-4. [DOI: 10.1007/s10147-010-0031-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/28/2009] [Indexed: 11/26/2022]
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Primitive neuroectodermal tumour (PNET) of the kidney: a rare renal tumour in adolescents with seemingly characteristic radiological features. Pediatr Radiol 2008; 38:1089-94. [PMID: 18712377 DOI: 10.1007/s00247-008-0971-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/02/2008] [Accepted: 06/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Primitive neuroectodermal tumours (PNETs) constitute a family of neoplasms of presumed neuroectodermal origin that predominantly present as bone or soft-tissue masses in adolescents and young adults. PNET arising in the kidney is rare. OBJECTIVE To describe the radiological features in three patients with primary renal PNET. MATERIALS AND METHODS The radiological features of primary renal PNET in three adolescent patients (age 10, 14 and 16 years) are described. RESULTS Tumour thrombus extending into the renal vein and inferior vena cava was noted in all three patients. In addition, further tumour extension into the atrium was seen in two patients with extension into a pulmonary artery in one patient. Neural foraminal and intraspinal extension close to the origin of the tumour was identified in two patients. Liver, bone and lung metastases were identified. CONCLUSION While rare, one should consider the diagnosis of PNET when encountering a renal mass with aggressive features such as inferior vena cava tumour thrombus, direct intraspinal invasion and distant metastasis.
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Primitive neuroectodermal tumor of the kidney: a single institute series of 16 patients. Urology 2008; 71:292-6. [PMID: 18308106 DOI: 10.1016/j.urology.2007.09.051] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 07/17/2007] [Accepted: 09/24/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Primitive neuroectodermal tumor (PNET) of the kidney is a rare entity, the diagnosis usually being made at histopathology. Few cases reported in literature revealed a variable presentation and an aggressive behavior. The purpose of our study was to review our experience in diagnosis and the management of patients with renal PNET. METHODS The records of 16 patients of renal PNET treated between 1995 and 2003 were reviewed retrospectively and our data compared with the literature. RESULTS There were 10 male and 6 female patients with median age of 27 years. At presentation, 10 patients (63%) had localized disease, 5 (31%) had metastatic disease and 1 (6%) had locally advanced disease. The presence of Homer-Wright type rosettes on hematoxylin and eosin staining and CD99 (cluster differentiation) products positivity on immunohistochemistry supported the diagnosis. Radical nephrectomy was performed in operable cases and all patients received chemotherapy. Nine patients received adjuvant radiotherapy to the renal bed. Median follow-up was 31 months (range 4 to 92). Overall median survival was 40 months with 3- and 5-year survival of 60% and 42%, respectively. CONCLUSIONS The diagnosis of renal PNET must be considered in young patients presenting with renal mass. Standard therapy consists of combination of surgical resection, postoperative irradiation and chemotherapy. Chemotherapy regimen used is either RCT II (round cell tumor) protocol or EFT 2001 (Ewing's family of tumors) protocol. However, further studies are required to validate the appropriate chemotherapy protocol.
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Ellinger J, Bastian P, Hauser S, Biermann K, Müller S. [Primitive neuroectodermal tumor of the kidney]. Urologe A 2007; 45:735-8. [PMID: 16534648 DOI: 10.1007/s00120-006-1029-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Primitive neuroectodermal Tumor (PNET) is a rare malignant tumor of young adult. Patients often present with the classical trias of renal cancer (pain, haematuria, palpable tumor). Specific radiological signs are missing, and therefore a PNET is often diagnosed postoperatively. It is characterized by the expression of MIC2, neural markers (Vimentin, S-100, Synaptophysin) and EWS/FLI1-translocation. The tumor is often diagnosed in advanced stage, and prognosis is poor despite of multimodal treatment including radical nephrectomy, polychemotherapy (vincristine, adriamycin, cyclophosphamid, etoposide, ifosfamide) and radiation in case of metastases or incomplete resection of primary tumor. We represent two cases of metastatic renal PNET in a 28- and 39-year-old patient. Due to the multimodal treatment a partial and a complete remission was achieved, respectively.
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Affiliation(s)
- J Ellinger
- Klinik und Poliklinik für Urologie, Rheinische Friedrich-Wilhelms Universität, Sigmund-Freud-Strasse 25, 53105, Bonn.
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Bernstein M, Kovar H, Paulussen M, Randall RL, Schuck A, Teot LA, Juergens H. Ewing's sarcoma family of tumors: current management. Oncologist 2006; 11:503-19. [PMID: 16720851 DOI: 10.1634/theoncologist.11-5-503] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ewing's sarcoma is the second most frequent primary bone cancer, with approximately 225 new cases diagnosed each year in patients less than 20 years of age in North America. It is one of the pediatric small round blue cell tumors, characterized by strong membrane expression of CD99 in a chain-mail pattern and negativity for lymphoid (CD45), rhabdomyosarcoma (myogenin, desmin, actin) and neuroblastoma (neurofilament protein) markers. Pathognomonic translocations involving the ews gene on chromosome 22 and an ets-type gene, most commonly the fli1 gene on chromosome 11, are implicated in the great majority of cases. Clinical presentation is usually dominated by local bone pain and a mass. Imaging reveals a technetium pyrophosphate avid lesion that, on plain radiograph, is destructive, diaphyseal and classically causes layered periosteal calcification. Magnetic resonance best defines the extent of the lesion. Biopsy should be undertaken by an experienced orthopedic oncologist. Approximately three quarters of patients have initially localized disease. About two thirds survive disease-free. Management, preferably at a specialist center with a multi-disciplinary team, includes both local control-either surgery, radiation or a combination-and systemic chemotherapy. Chemotherapy includes cyclic combinations, incorporating vincristine, doxorubicin, cyclophosphamide, etoposide, ifosfamide and occasionally actinomycin D. Topotecan in combination with cyclophosphamide has shown preliminary activity. Patients with initially metastatic disease fare less well, with about one quarter surviving. Studies incorporating intensive therapy followed by stem cell infusion show no clear benefit. New approaches include anti-angiogenic therapy, particularly since vascular endothelial growth factor is an apparent downstream target of the ews-fli1 oncogene.
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Affiliation(s)
- Mark Bernstein
- Service of Hematology/Oncology, Ste-Justine Hospital, University of Montreal, 3175 Cote Ste. Catherine Road, Montreal, Quebec, H3T 1C5, Canada.
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Erkiliç S, Ozsaraç C, Koçer NE, Erbağci A. Primary primitive neuroectodermal tumor of the kidney: A case report. Int Urol Nephrol 2006; 38:199-202. [PMID: 16868682 DOI: 10.1007/s11255-006-6675-2] [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: 11/27/2022]
Abstract
There are nearly 50 PNET cases in the literature with primary renal localization. The mean age for renal PNET is 28 but it can be seen in a wide range between 4 and 69 years. In this atypical localization PNET may be mistaken with a variety of small round cell tumors, particularly with blastema predominant Wilms' tumor and due to its distinctive prognostic and therapeutic features differential diagnosis is very important. Immunohistochemical studies are useful in discriminating PNET from other renal small round cell tumors. Renal PNETs tend to metastasize at early stages and they have a high rate of recurrence. Our case is a 45-year-old male presented with left flank pain and hematuria. In computerized tomography a mass in left kidney was observed and nephrectomy was performed. Histopathologic examination revealed a small round cell tumor with rosettes and pseudorosettes. Immunohistochemically the lesion was diffuse strong positive with CD99 and NSE, negative with LCA, pancytokeratin, vimentin, desmin, smooth muscle actin, chromogranine A and S-100. At the time of diagnosis the pathologic stage of the tumor was T1aN0Mx. The patient did not take any further therapy and in 1-year follow-up no local recurrence or distant metastasize occurred.
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Affiliation(s)
- Suna Erkiliç
- Department of Pathology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
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23
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Huang KH, Shun CT, Huang SY, Yu HJ, Chueh SC, Chen J. Primary Primitive Neuroectodermal Tumor of the Urinary Tract. J Formos Med Assoc 2006; 105:1008-12. [PMID: 17185243 DOI: 10.1016/s0929-6646(09)60285-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Primary primitive neuroectodermal tumor (PNET) of the urinary tract is a rare disease with aggressive behavior and poor prognosis. We analyzed 851 cases of urinary tract malignancies in our hospital between 1984 and 2004. Only three (0.035%) cases with PNET of the urinary tract were identified. Presenting symptoms included flank pain and hematuria. The first case was a 44-year-old man with left renal PNET who underwent hand-assisted laparoscopic radical nephrectomy and adjuvant chemotherapy. There was no recurrent tumor at the 4-year follow-up. The second case was a 75-year-old woman with right renal PNET with inferior vena cava (IVC) thrombosis extending to the right atrium. The patient underwent right radical nephroureterectomy and IVC thrombectomy with cardiopulmonary bypass. She died of metastatic disease 7 months later. The third case was a 45-year-old man with left ureteral PNET. Left ureteral segmental resection and partial cystectomy were performed. Tumor recurrence was noted 7 years later. The patient died of disseminated disease 1 year after the discovery of recurrence. Urinary tract PNET appears to be an aggressive malignancy. Long-term survival is possible if complete resection is performed at an early stage.
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Affiliation(s)
- Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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24
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Sun G, Li Z, Li J, Wang C. Peripheral primitive neuroectodermal tumour of the maxilla. Br J Oral Maxillofac Surg 2005; 45:226-7. [PMID: 16203064 DOI: 10.1016/j.bjoms.2005.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 07/29/2005] [Indexed: 11/29/2022]
Abstract
The peripheral primitive neuroectodermal tumour (pPNET) is a rare and highly malignant soft tissue neoplasm in children and young adults. We present a case of pPNET of the maxilla in a 49-year-old woman.
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Affiliation(s)
- Guowen Sun
- Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan 430079, PR China.
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Pomara G, Cappello F, Cuttano MG, Rappa F, Morelli G, Mancini P, Selli C. Primitive Neuroectodermal Tumor (PNET) of the kidney: a case report. BMC Cancer 2004; 4:3. [PMID: 14969593 PMCID: PMC331414 DOI: 10.1186/1471-2407-4-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2003] [Accepted: 01/26/2004] [Indexed: 11/13/2022] Open
Abstract
Background A case of Primitive Neuroectodermal Tumor (PNET) of the kidney in a 27-year-old woman is presented. Few cases are reported in the literature with a variable, nonspecific presentation and an aggressive behaviour. In our case, a radical nephrectomy with lymphadenectomy was performed and there was no residual or recurrent tumour at 24-month follow-up. Methods The surgical specimens were formalin-fixed and paraffin embedded. The sections were stained with routinary H&E. Immunohistochemistry was performed. Results The immunohistochemical evaluation revealed a diffuse CD99 positivity in the cytoplasm of the neoplastic cells. Pankeratin, cytokeratin AE1/AE3, vimentin, desmin, S100, cromogranin were negative. The clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristic and the cellular immunophenotype addressed the diagnosis towards primary PNET of kidney. Conclusions Since sometimes it is difficult to discriminate between PNET and Ewing's tumour, we reviewed the difficulties in differential diagnosis. These tumors have a common precursor but the stage of differentiation in which it is blocked is probably different. This could also explain their different biological behaviour and prognosis.
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Affiliation(s)
- Giorgio Pomara
- Department of Surgery – Urology Section – S. Chiara Hospital – University of Pisa, Pisa – Italy
| | - Francesco Cappello
- Department of Experimental Medicine – Human Anatomy Section – University of Palermo, Palermo – Italy
| | - Maria G Cuttano
- Department of Surgery – Urology Section – S. Chiara Hospital – University of Pisa, Pisa – Italy
| | - Francesca Rappa
- Department of Experimental Medicine – Human Anatomy Section – University of Palermo, Palermo – Italy
| | - Girolamo Morelli
- Department of Surgery – Urology Section – S. Chiara Hospital – University of Pisa, Pisa – Italy
| | - Pierantonio Mancini
- Department of Surgery – Urology Section – S. Chiara Hospital – University of Pisa, Pisa – Italy
| | - Cesare Selli
- Department of Surgery – Urology Section – S. Chiara Hospital – University of Pisa, Pisa – Italy
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Abstract
Over the past 6 years, molecular genetic studies have significantly advanced our understanding of pediatric renal neoplasms. The cellular variant of congenital mesoblastic nephroma (but not the classic variant) has been shown to bear the same t(12;15)(p13;q25) and ETV6-NTRK3 gene fusion as infantile fibrosarcoma, a tumor with which it shares morphologic and clinical features. Rhabdoid tumor of the kidney is characterized by deletion of the hSNF5/INI1 gene, which links it to other rhabdoid tumors of infancy that arise in the soft tissue and brain. Primary renal synovial sarcomas and renal primitive neuroectodermal tumors have become accepted entities, and likely comprise a subset of what had previously been termed "adult Wilms tumor." Renal carcinomas associated with Xp11.2 translocations that result in fusions involving the TFE3 transcription factor gene have been delineated, including a distinctive neoplasm that shares the identical gene fusion as alveolar soft part sarcoma. Most recently, a distinctive type of renal neoplasm with a t(6;11)(p21;q12) has been described, and the cloning of the resulting gene fusion links it to the Xp11 translocation carcinomas. Together, these last two translocation-associated tumors represent a significant proportion of pediatric renal cell carcinomas. This review highlights each of these recent advances.
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Affiliation(s)
- Pedram Argani
- The Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
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27
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Thomas JC, Sebek BA, Krishnamurthi V. Primitive neuroectodermal tumor of the kidney with inferior vena cava and atrial tumor thrombus. J Urol 2002; 168:1486-7. [PMID: 12352425 DOI: 10.1016/s0022-5347(05)64481-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- John C Thomas
- Urological Institute and Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio, USA
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Jimenez RE, Folpe AL, Lapham RL, Ro JY, O'Shea PA, Weiss SW, Amin MB. Primary Ewing's sarcoma/primitive neuroectodermal tumor of the kidney: a clinicopathologic and immunohistochemical analysis of 11 cases. Am J Surg Pathol 2002; 26:320-7. [PMID: 11859203 DOI: 10.1097/00000478-200203000-00005] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) is an extraordinarily rare primary tumor in the kidney and can be mistaken for a variety of other round cell tumors, including blastema-predominant Wilms' tumor (WT). Approximately 90% of ES/PNET have a specific t(11;22), which results in a chimeric EWS-FLI-1 protein. Immunohistochemistry for the carboxy-terminus of FLI-1 is sensitive and highly specific for the diagnosis of ES/PNET. WT-1, the WT-associated tumor suppressor gene, is overexpressed in WT but not in ES/PNET. No study has examined FLI-1 or WT-1 expression in renal ES/PNET. The clinicopathologic features of 11 renal ES/PNET were studied along with immunohistochemistry for cytokeratin, desmin, CD99, FLI-1, and WT-1. WT were also immunostained for CD99 (5 cases), FLI-1 (10 cases), and WT-1 (9 cases). The patients (6 men, 5 women) ranged from 18 to 49 years of age (mean, 34 yr). The mean tumor size was 11.8 +/- 3.8 cm (mean +/- standard deviation). Presenting symptoms included abdominal/flank pain and/or hematuria. Grossly, all tumors showed necrosis and hemorrhage, and 4 had cystic change. Microscopically, all tumors showed vaguely lobular growth, primitive round cells, and variable rosette formation. Epithelial, myogenous, or cartilaginous differentiation was not seen. Immunohistochemical results on the renal ES/PNET were cytokeratin (2/8 focal), desmin (0/9), CD99 (8/8), FLI-1 (5/8), and WT-1 (0/8). In comparison, the WT only rarely expressed CD99 (1/5) and did not express FLI-1 (0/10), but were usually WT-1-positive (7/9). Follow-up on 8 cases (mean, 28 mo; range, 6-64 mo) showed 4 lung and pleural metastases, 1 bone metastasis, liver metastasis, 2 local recurrences, and 5 deaths from disease (median time to death, 16.8 mo). No case had distant metastatic disease at presentation. Adjuvant therapy included chemotherapy (8 cases), radiation (3 cases), and bone marrow transplantation (1 case). Our study affirms a unique proclivity of renal ES/PNET for young adults and that it is a highly aggressive neoplasm, with rapid death in many cases, usually after the development of treatment-resistant lung metastases. These tumors must be distinguished from blastema-predominant WT and other primitive renal tumors that require different therapy. FLI-1 and WT-1 immunohistochemistry may be valuable in this differential diagnosis, given the known immunophenotypic overlap between ES/PNET and blastema-predominant WT with regard to CD99, cytokeratin, and desmin. The accurate distinction between these two entities has clear prognostic and therapeutic implications.
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MESH Headings
- 12E7 Antigen
- Adult
- Aged
- Antigens, CD/analysis
- Cell Adhesion Molecules/analysis
- Child
- Combined Modality Therapy
- DNA-Binding Proteins/analysis
- Desmin/analysis
- Diagnosis, Differential
- Female
- Genes, Tumor Suppressor
- Humans
- Immunohistochemistry
- Keratins/analysis
- Kidney Neoplasms/chemistry
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Metastasis
- Neuroectodermal Tumors, Primitive/chemistry
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive/therapy
- Proto-Oncogene Protein c-fli-1
- Proto-Oncogene Proteins
- Sarcoma, Ewing/chemistry
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/therapy
- Trans-Activators/analysis
- WT1 Proteins/analysis
- Wilms Tumor/chemistry
- Wilms Tumor/genetics
- Wilms Tumor/pathology
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Affiliation(s)
- Rafael E Jimenez
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
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