1
|
Khalid H, Hussain N, Shamshad R. Esophageal extraskeletal neoplasm Ewing's sarcoma: Case report. Int J Surg Case Rep 2022; 97:107399. [PMID: 35926382 PMCID: PMC9403063 DOI: 10.1016/j.ijscr.2022.107399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Ewing sarcomas are a group of small round cell tumors that occur predominantly in the long bones as well as in extraosseous locations such as the extremities, trunk, and retroperitoneum (Gier, 1997) [2]. Extraosseous Ewing sarcoma (EES) is a type of small round cell tumor that occurs in soft tissues. I rare cases, EES occurs in the esophagus (Maesawa et al., 2002; Johnson et al., 2010) [1,3]. Ewing's sarcoma is a rare and highly aggressive cancer most frequently arising in people under 20 years of age. We report an uncommon case of primary paraesophageal Ewing's sarcoma in a 25-year-old female. CASE PRESENTATION A 26 years old Asian female referred primarily for surgical treatment due to esophageal cancer detected on her diagnostic investigations and revealed a primary tumor located near the gastroesophageal junction. Based on the results of diagnostic investigations which confirmed the possibility of the tumor Ewing sarcoma of esophagus, which was biopsy and immune histochemical stain proven the patient was qualified for surgical treatment. She underwent Mckewon esophagectomy on October 2021 for Ewing sarcoma of esophagus. She was first followed with neoadjuvant intravenous chemotherapy, after taking three cycles of neoadjuvant chemo showed good response in CT scan the patient underwent Mckewon esophagectomy, post op recovery was smooth she underwent 2 cycles of adjuvant chemotherapy after four months of surgery. Her followup visit was uneventful. CLINICAL DISCUSSION Ewing's sarcoma is the second most frequent primary malignant bone cancer, after osteosarcoma. It was first described by James Ewing in 1921, as an undifferentiated tumor developing in the diaphysis of the ulna of a young female patient (Ushigome et al., 2002) [6]. Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET), previously thought to be separate tumors, is now treated as the same tumor; both have similar immunohistochemical characteristics and chromosomal translocation (Maesawa et al., 2002) [1]. They are malignant tumors composed of undifferentiated small round cells, usually affecting children, adolescents, and young adults (Kondo et al., 2005) [7]. Generally ES/PNET affects the bones and deep soft tissues (Soulard et al., 2005) [8], although other organs such as the pancreas, small bowel, esophagus, kidneys, prostate, ovaries, vagina and rectovaginal septum have been reported; this is termed as extraskeletal ES/PNET (Bloom et al., 1995) [9]. To the best of our knowledge, only 5 cases of gastric ES/PNET have been reported in the English language literature. Extraskeletal Ewing's sarcoma is a very rare disease, accounting for 6 %-47 % of all cases of Ewing's sarcoma. It is mainly diagnosed in the trunk, extremities, retroperitoneum, and head and neck region. Patients with extraosseous Ewing's sarcoma are more likely to be older, female, and not of Caucasian origin. An extraskeletal origin of the disease is correlated to poor prognosis (Siegel et al., 1988; Granowetter and West, 1997; Ushigome et al., 2002) [4-6]. We present an uncommon case of extraskeletal Ewing's sarcoma, and discuss its rare presentation and evolution. To our knowledge, this is the first reported case of paraesophageal primary Ewing's sarcoma and primitive neuroectodermal tumor. Adenocarcinoma and squamous cell carcinoma account for the vast majority of esophageal malignancies. Other malignancies known to occur in the esophagus include melanoma, sarcoma, and lymphoma. Among the sarcomas, carcinosarcoma is the commonest with both carcinomatous and sarcomatous elements followed by leiomyosarcoma of mesenchymal origin. Other sarcomas reported in the literature are liposarcoma, synovial sarcoma, myxofibrosarcoma, Ewing's sarcoma, granulocytic sarcoma, histiocytic sarcoma, schwannoma rhabdomyosarcoma, and epithelioid sarcoma. CONCLUSION Ewing sarcoma is a rare entity among all esophageal malignancies. It presents as an exophytic mass, and in this case, it has presented as a mass occluding the lumen of esophagus. Most of these tumors present in locally advanced and disseminated condition, one of the reasons being difficulty and hence delay in diagnosis. In spite of best efforts, a group among them remains to be histologically uncharacterized.
Collapse
Affiliation(s)
- Hina Khalid
- Dow University of Health Sciences, Karachi, Pakistan,Corresponding author.
| | - Niaz Hussain
- Department of Thoracic Surgery, Ojha Institute of Chest Disease, Pakistan
| | | |
Collapse
|
2
|
Yang J, Wei H, Lin Y, Lin N, Wu S, Yu X. Challenges of Diagnosing Primary Ewing's Sarcoma in the Small Intestine of the Elderly: A Case Report. Front Oncol 2021; 11:565196. [PMID: 34307115 PMCID: PMC8299103 DOI: 10.3389/fonc.2021.565196] [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: 06/24/2020] [Accepted: 06/24/2021] [Indexed: 12/26/2022] Open
Abstract
Extraosseous Ewing's sarcoma (EES) is a malignant tumor that is classified as a rare disease. EES is common in children and adolescents, with a rarer incidence being present in the elderly. ES of the primary intestine is rare, with only a few reports described in the literature. Here we report a case of a 69-year-old male patient who was experiencing abdominal pain for over 3 months. Ultrasonography (US) revealed a solid hypoechoic lesion with multiple irregular necrotic areas in the left lower abdomen close to the dome of the bladder. Contrast-enhanced ultrasonography (CEUS) showed that the lesion exhibited heterogeneous enhancement and quick peripheral enhanced tissue wash-out classifying this mass as malignant. PET-CT showed a high metabolic mass in the lower abdomen, multiple metabolic nodules in the mesentery, considered as a small intestinal stromal tumor with lymph nodes metastasis, and that a diagnosis of lymphoma should be excluded. Esophagogastroduodenoscopy performed at another hospital 1 month prior to CT showed an abnormal density in the pelvic cavity that was considered as a colonic diverticulum with an abscess. The endoscopy showed no obvious occupying lesions. The mass was removed and postoperative pathology confirmed ES of the small intestine. The patient avoided receiving chemotherapy. After 2 months, skull metastasis was diagnosed and surgical intervention was done. His survival was only six months after the second surgery. To our knowledge, our case is the first report of ultrasound and CEUS manifestation of EES in the small intestine in elderly.
Collapse
Affiliation(s)
- Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Hong Wei
- Department of Cadre Health Care Office, Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yucheng Lin
- Department of Ultrasonography, Affiliate Fuzhou First Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Ning Lin
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xunbin Yu
- Department of Pathology, Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| |
Collapse
|
3
|
Shadhu K, Ramlagun-Mungur D, Ping XC. Ewing sarcoma of the jejunum: A case report and literature review. World J Gastrointest Surg 2021; 13:507-515. [PMID: 34122739 PMCID: PMC8167841 DOI: 10.4240/wjgs.v13.i5.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ewing sarcomas (ESs) are highly aggressive malignancy and are predominant in the long bones of extremities of children and young adults with a slight male predilection and rarely presents at extra skeletal locations.
CASE SUMMARY A 55-year-old woman came to our hospital after finding elevated tumor biomarkers during her physical examination. Her enhanced computed tomography scan showed a jejunal mass. The patient underwent laparoscopic enterectomy. The mass was later diagnosed as ES, evidenced by fluorescence in situ hybridization whereby the GLP ES breakpoint region 1 probe was used, showing that more than 10% of the cells showed a red-green-yellow signal proving the breakpoint rearrangement of the ES breakpoint region 1 gene in chromosome 22.
CONCLUSION We describe a case of localized ES at the jejunum in China based on the literature.
Collapse
Affiliation(s)
- Kamleshsingh Shadhu
- Department of General Surgery, Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Pre-registration House Officer, Medical Council of Mauritius, Floreal 0000, Plaine Whilhems, Mauritius
| | - Dadhija Ramlagun-Mungur
- Department of General Surgery, Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Pre-registration House Officer, Medical Council of Mauritius, Floreal 0000, Plaine Whilhems, Mauritius
| | - Xiao-Chun Ping
- Department of General Surgery, Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| |
Collapse
|
4
|
Krakorova DA, Halamkova J, Tucek S, Bilek O, Kristek J, Kazda T, Zambo IS, Demlova R, Kiss I. Penis as a primary site of an extraskeletal Ewing sarcoma: A case report. Medicine (Baltimore) 2021; 100:e25074. [PMID: 33725983 PMCID: PMC7982170 DOI: 10.1097/md.0000000000025074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The Ewing sarcoma family of malignant tumors is a group of tumors characterized by morphologically similar round-cell neoplasms and by the presence of a common chromosomal translocation; Ewing sarcoma family of tumors typically occur in children and young adults between 4 to 15 years of age. The primary tumor usually originates in the bone, extraskeletal localization is rare. PATIENT CONCERN We present a case report concerning a 32-year-old male patient with a primary involvement of the penis. DIAGNOSIS The histopathology from the first penile biopsy showed a small-cell neuroendocrine carcinoma; however, that result was based on a sample obtained at a different facility than the Sarcoma Center, where the investigating pathologist did not have the adequate expertise. The patient then underwent a radical penectomy and a second reading of the histology was demanded after a radical penile amputation when Ewing sarcoma with R1 resection was confirmed. INTERVENTIONS The patient was referred to the national Sarcoma Center, where - using a multidisciplinary approach - the treatment was started with curative intent. However, it was preceded by a non-standard initiation of the therapy due to the poor primary diagnosis. OUTCOMES The non-standard therapy at the onset of the disease caused a poor prognosis of an otherwise curable diagnosis. Despite all that, the patient survived for a relatively long time. LESSONS The treatment of sarcomas with atypical localizations should be conducted by an experienced multidisciplinary team in a center with experience in sarcoma treatment.
Collapse
Affiliation(s)
| | - Jana Halamkova
- Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Zluty kopec 7, 656 53 Brno, Czech Republic And Department of Medical Ethics, Faculty of Medicine Masaryk University, Kamenice 25
| | - Stepan Tucek
- Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Zluty kopec 7
| | - Ondrej Bilek
- Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Zluty kopec 7
| | - Jan Kristek
- Department of Radiology, Masaryk Memorial Cancer Institute Zluty kopec 7
| | - Tomas Kazda
- Assoc. Prof. Department of Radiation Oncology Masaryk Memorial Cancer Institute Faculty of Medicine Masaryk University Zluty kopec 7
| | - Iva Staniczkova Zambo
- Department of Pathology, St. Anne's University Hospital, Faculty of Medicine Masaryk University Pekarska 53
| | - Regina Demlova
- Assoc. Prof. Clinical Trial Unit, Masaryk Memorial Cancer Institute Zluty kopec 7, 656 53 Brno, Czech Republic And Department of Pharmacology, Faculty of Medicine Masaryk University, Kamenice 25
| | - Igor Kiss
- Assoc. Prof. Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute Faculty of Medicine Masaryk University Zluty kopec 7, Brno, Czech Republic
| |
Collapse
|
5
|
Wang S, Zhu W, Zhang H, Yang X. Extraosseous Ewing Sarcoma of the Cervical Esophagus: Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 101:NP203-NP208. [PMID: 32921182 DOI: 10.1177/0145561320953696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study presents a case of Extraosseous Ewing sarcoma arising in the cervical esophagus of a 36-year-old woman who presented with cervical mass and dysphagia. Imaging studies demonstrated a well-defined, cystic-solid mass in the neck extending into the upper mediastinum, which results in deviation of the trachea and esophagus. The relationship between the tumor and the cervical esophagus was found in the operation. The patient underwent localized tumor resection without radical esophagectomy. The accurate diagnosis was obtained by the immunohistochemistry and molecular genetic assay. Although this is a rare site for this type of tumor to occur, extraosseous Ewing sarcoma should be considered in the differential diagnosis of small round cell tumors of the cervical esophagus. The postoperative chemotherapy and radiotherapy are of great value in improving the prognosis of cervical esophageal Ewing sarcoma.
Collapse
Affiliation(s)
- Shuang Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, 12570Central South University, Changsha, Hunan, People's Republic of China
| | - Weiyu Zhu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital & Shenzhen Hospital, 12501Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong, People's Republic of China
| | - Hongbo Zhang
- Department of Pathology, The Second Xiangya Hospital, 12570Central South University, Changsha, Hunan, People's Republic of China
| | - Xinming Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, 12570Central South University, Changsha, Hunan, People's Republic of China
| |
Collapse
|
6
|
Kenny C, Grehan D, Ulas M, Banga GB, Coulomb A, Vokuhl C, O'Sullivan MJ. Immunophenotype-Genotype Correlations in Clear Cell Sarcoma of Kidney-An Evaluation of Diagnostic Ancillary Studies. Pediatr Dev Pathol 2020; 23:345-351. [PMID: 32364435 DOI: 10.1177/1093526620910658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of this study was to establish a reliable panel of antibodies for immunohistochemical corroboration of a diagnosis of clear cell sarcoma of kidney (CCSK), taking into consideration the various genotypic subsets of CCSK. METHODS We conducted full genotypic analysis for evidence of YWHAE-NUTM2, BCOR internal tandem duplication (ITD), and BCOR-CCNB3 in 68 archival cases of CCSK and then immunostained all cases for CCND1, TLE1, and BCOR along with 63 control samples representing tumor types that may enter into the differential diagnosis of CCSK, including 7 congenital mesoblastic nephromas, 2 desmoplastic small round cell tumors, 13 malignant rhabdoid tumors, 9 Ewing sarcomas/primitive neuroectodermal tumor, 5 synovial sarcomas, and 27 Wilms' tumors. RESULTS Molecular assays showed that 54 CCSKs harbored a BCOR-ITD, 1 case expressed a YWHAE-NUTM2 fusion transcript while none expressed the BCOR-CCNB3 fusion. The remaining 13 CCSKs were designated "triple-negative" based on the molecular findings. CCND1 showed positive immunoreactivity across all subgroups. TLE1 was positive in 94% of cases, including 1 YWHAE-NUTM2 fusion-positive case. Three BCOR-ITD-positive tumors were TLE1-negative. BCOR immunostaining was most variable among subgroups, with triple-negative tumors showing the weakest staining. In all, 10/68 (15%) tumors did not stain for BCOR, of which 4 were triple-negative (4/13 = 31%) and 6 were BCOR-ITD-positive (6/54 = 11%). The single YWHAE-NUTM2-positive tumor showed strong staining for all 3 markers. No single case was negative for all 3 stains; however, 3 cases showed no reactivity for either BCOR or TLE1 of which 1 was triple-negative and 2 BCOR-ITD-positive. CONCLUSION Having completed the first comprehensive evaluation of immunostaining of 68 fully genotyped CCSK tumors, we show herein that there is a rationale for the use of a small panel of antibodies to assist in the diagnosis of CCSK regardless of genotype, and we demonstrate that in combination CCND1, TLE1, and BCOR are compelling markers in aiding CCSK diagnosis.
Collapse
Affiliation(s)
- Colin Kenny
- Trinity College, University of Dublin, Dublin, Ireland.,Oncology Division, The National Children's Research Center, Our Lady's Children's Hospital, Dublin, Ireland
| | - David Grehan
- Histology Laboratory, Our Lady's Children's Hospital, Dublin, Ireland
| | - Mevlut Ulas
- Trinity College, University of Dublin, Dublin, Ireland.,Oncology Division, The National Children's Research Center, Our Lady's Children's Hospital, Dublin, Ireland
| | - Gloria Badi Banga
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Armand Trousseau, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Aurore Coulomb
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Armand Trousseau, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christian Vokuhl
- Kiel Pediatric Cancer Registry, Christian Albrechts University, Kiel, Germany
| | - Maureen J O'Sullivan
- Trinity College, University of Dublin, Dublin, Ireland.,Oncology Division, The National Children's Research Center, Our Lady's Children's Hospital, Dublin, Ireland.,Histology Laboratory, Our Lady's Children's Hospital, Dublin, Ireland
| |
Collapse
|
7
|
Businello G, Dal Pozzo CA, Sbaraglia M, Mastracci L, Milione M, Saragoni L, Grillo F, Parente P, Remo A, Bellan E, Cappellesso R, Pennelli G, Michelotto M, Fassan M. Histopathological landscape of rare oesophageal neoplasms. World J Gastroenterol 2020; 26:3865-3888. [PMID: 32774063 PMCID: PMC7385561 DOI: 10.3748/wjg.v26.i27.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin, in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. However, several other histopathological variants can be distinguished, some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice. The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.
Collapse
Affiliation(s)
- Gianluca Businello
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Carlo Alberto Dal Pozzo
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Luca Mastracci
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Italy
| | - Andrea Remo
- Department of Pathology, Ospedale Mater Salutis di Legnago, Legnago 37045, Italy
| | - Elena Bellan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Mauro Michelotto
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| |
Collapse
|
8
|
Chen HJ, Chao HM, Chang JL, Chen YL, Yen CC. Primary Ewing's sarcoma of the jejunum presenting as sepsis. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_101_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Bong C, Thomson I, Lampe G. Case report and literature review of Ewing's sarcoma in the gastrointestinal tract. SURGICAL PRACTICE 2018; 22:84-92. [DOI: 10.1111/1744-1633.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Christopher Bong
- Department of Upper Gastrointestinal Surgery and Soft Tissue; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Iain Thomson
- Department of Upper Gastrointestinal Surgery and Soft Tissue; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Guy Lampe
- Department of Anatomical Pathology; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| |
Collapse
|
10
|
Mege D, Depypere L, Piessen G, Slaman AE, Wijnhoven BPL, Hölscher A, Nilsson M, van Berge Henegouwen MI, van Lanschot JJB, Schroeder W, Thomas PA, Nafteux P, D'Journo XB. Surgical management of esophageal sarcoma: a multicenter European experience. Dis Esophagus 2018; 31:4850444. [PMID: 29444281 DOI: 10.1093/dote/dox146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022]
Abstract
Esophageal sarcomas are rare and evidence in literature is scarce making their management difficult. The objective is to report surgical and oncological outcomes of esophageal sarcoma in a large multicenter European cohort. This is a retrospective multicenter study including all patients who underwent en-bloc esophagectomy for esophageal sarcoma in seven European tertiary referral centers between 1987 and 2016. The main outcomes and measures are pathological results, early and long-term outcomes. Among 10,936 esophageal resections for cancer, 21 (0.2%) patients with esophageal sarcoma were identified. The majority of tumors was located in the middle (n = 7) and distal (n = 9) third of the esophagus. Neoadjuvant chemoradiotherapy was performed in five patients. All the patients underwent en-bloc transthoracic esophagectomy (19 open, 2 minimally invasive). Postoperative mortality occurred in 1 patient (5%). One patient received adjuvant chemotherapy. Definitive pathological results were carcinosarcoma (n = 7), leiomyosarcoma (n = 5), and other types of sarcoma (n = 9). Microscopic R1 resection was present in one patient (5%) and seven patients (33%) had positive lymph nodes. Median follow-up was 16 (3-79) months in 20 of 21 patients (95%). One-, 3-, and 5-year overall survival rates were 74%, 43%, and 35%, respectively. One-, 3- and 5-years disease-free survival rates were 58%, 40%, and 33%, respectively. Median overall survival was 6 months in N+ patients vs. 37 months for N0 patients (p = 0.06). At the end of the follow-up period, nine patients had died from cancer recurrences (43%), three patients died from other reasons (14%), one patient was still alive with recurrence (5%) and the seven remaining patients were free of disease (33%). Recurrence was local (n = 3), metastatic (n = 3), or both (n = 4). In conclusion, carcinosarcoma and leiomyosarcoma were the most common esophageal sarcoma histological subtypes. Lymph node involvement was seen in one third of cases. A transthoracic en-bloc esophagectomy with radical lymphadenectomy should be the best surgical option to achieve complete resection. Long-term survival remained poor with a high local and distant recurrence rate.
Collapse
Affiliation(s)
- D Mege
- Department of Thoracic and Esophageal Surgery, Marseille
| | - L Depypere
- Department of Thoracic Surgery, Leuven, Belgium
| | - G Piessen
- Department of Digestive and Oncological Surgery, Lille, France
| | - A E Slaman
- Department of Surgery and Amsterdam Cancer Center, Amsterdam
| | - B P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - M Nilsson
- Department of Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - J J B van Lanschot
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - P A Thomas
- Department of Thoracic and Esophageal Surgery, Marseille
| | - P Nafteux
- Department of Thoracic Surgery, Leuven, Belgium
| | - X B D'Journo
- Department of Thoracic and Esophageal Surgery, Marseille
| |
Collapse
|
11
|
Li T, Zhang F, Cao Y, Ning S, Bi Y, Xue W, Ren L. Primary Ewing's sarcoma/primitive neuroectodermal tumor of the ileum: case report of a 16-year-old Chinese female and literature review. Diagn Pathol 2017; 12:37. [PMID: 28472972 PMCID: PMC5418692 DOI: 10.1186/s13000-017-0626-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/17/2017] [Indexed: 12/21/2022] Open
Abstract
Background Ewing’s sarcoma (ES) and primitive neuroectodermal tumors (PNET) are closely related tumors. Although soft tissue ES/PNET are common in clinical practice, they are rare in the small intestine. Because of the absence of characteristic clinical symptoms, they are easily misdiagnosed as other benign or malignant diseases. Case presentation Here, we present the case of a 16-year-old female who complained of anemia and interval hematochezia. Her serum test results showed only a slight elevation of CA-125 and a low level of hemoglobin. Computer tomography and magnetic resonance imaging revealed a cystic and solid mass in the lower abdominal quadrant and pelvic region, which prompted suspicion of a malignant gastrointestinal stromal tumor of the small intestine. After resection, the tumor’s histology and immunohistochemistry (positive for CD99, vimentin and synaptophysin) results suggested ES/PNET. Fluorescent in situ hybridization tests proved the breakpoint rearrangement of the EWSR1 gene in chr 22.Ultrastructural analysis revealed neurosecretory and glycogen granules in the tumor cell cytoplasm. Conclusions Together, these data supported the diagnosis of a rare case of localized ES/PNET in the small intestine without adjuvant chemo- or radiotherapy. To our knowledge, this is the first report from China of a primary small bowel ES/PNET in the English-language literature. In addition, on the basis of findings from previous publications and the current case, the optimal treatment for localized gastrointestinal ES/PNET is discussed.
Collapse
Affiliation(s)
- Teng Li
- Department of Pathology, The General Hospital of Air force, PLA, Fucheng Road 30th, Beijing, China
| | - Fang Zhang
- Department of Pathology, The General Hospital of Air force, PLA, Fucheng Road 30th, Beijing, China
| | - Yarui Cao
- Department of Pathology, The General Hospital of Air force, PLA, Fucheng Road 30th, Beijing, China
| | - Shoubin Ning
- Department of Gastroenterology, The General Hospital of Air force, PLA, Fucheng Road 30th, Beijing, China
| | - Yongmin Bi
- Department of Radio and Imaging, The General Hospital of Air force, PLA, Fucheng Road 30th, Beijing, China
| | - Weicheng Xue
- Department of Pathology, Beijing Cancer Hospital, Fucheng Road 52nd, Beijing, China
| | - Li Ren
- Department of Pathology, The General Hospital of Air force, PLA, Fucheng Road 30th, Beijing, China.
| |
Collapse
|
12
|
Kie JH, Lee MK, Kim CJ, Lee K, Kwon KW, Yang WI. Primary Ewing's Sarcoma of the Duodenum: A Case Report. Int J Surg Pathol 2016; 11:331-7. [PMID: 14615834 DOI: 10.1177/106689690301100416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of Ewing's sarcoma arising from the duodenum in a 20-year-old woman who presented with a rapidly progressive ulcerative lesion. The surgical specimen obtained via Whipple's operation revealed a small round-cell tumor (SRCT) in the first and second portion of the duodenum. The tumor cells revealed strong immunoreactivity for CD 99 and vimentin and focal paranuclear dot-like immunoreactivity for cytokeratin. Electron microscopy showed primitive tumor cells with few cytoplasmic organelles, but neither neurosecretory granules nor specific cell junctions were present. On Western blot study, 68-kDa EWS/FLIl fusion protein was detected. The occurrence of Ewing's sarcoma in the gastrointestinal hollow viscus has recently been recognized, and this case expands the known anatomic sites that can harbor Ewing's sarcoma by demonstrating primary duodenal involvement.
Collapse
MESH Headings
- Adult
- Biomarkers, Tumor/analysis
- Blotting, Western
- Duodenal Neoplasms/metabolism
- Duodenal Neoplasms/pathology
- Duodenal Neoplasms/ultrastructure
- Female
- Humans
- Immunohistochemistry
- Microscopy, Electron
- Neuroectodermal Tumors, Primitive, Peripheral/metabolism
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/ultrastructure
- Oncogene Proteins, Fusion/metabolism
- Proto-Oncogene Protein c-fli-1
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/ultrastructure
- Transcription Factors/metabolism
Collapse
Affiliation(s)
- Jeong-Hae Kie
- Department of Pathology, National Health Insurance Cooperation Ilsan Hospital, Koyang, Korea
| | | | | | | | | | | |
Collapse
|
13
|
Primitive Neuroectodermal Tumor (PNET) of the Small Bowel in a Young Adult with Lower Gastrointestinal Bleeding. J Gastrointest Cancer 2016; 43 Suppl 1:S243-5. [PMID: 22760712 DOI: 10.1007/s12029-012-9409-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
14
|
Turkyilmaz Z, Sonmez K, Karabulut R, Sen MC, Poyraz A, Oguz A, Basaklar AC. Extraskeletal Ewing sarcoma of the mesocolon in a child. J Pediatr Surg 2012; 47:E1-3. [PMID: 22974628 DOI: 10.1016/j.jpedsurg.2012.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 12/01/2022]
Abstract
Ewing sarcoma (ES) is a malignant neoplasm usually affecting the skeletal system. Extraskeletal ES is a rare tumor. To date, only 1 case of primary mesocolon ES has been previously reported in an adult. Herein, we present the first case of ES in the mesocolon in a child.
Collapse
Affiliation(s)
- Zafer Turkyilmaz
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
15
|
Rare Cause of Stricture Esophagus-Sarcoma: A Case Report and Review of the literature. Case Rep Gastrointest Med 2011; 2011:192423. [PMID: 22606414 PMCID: PMC3350176 DOI: 10.1155/2011/192423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 07/20/2011] [Indexed: 12/04/2022] Open
Abstract
Adenocarcinoma and squamous cell carcinoma account for the vast majority of oesophageal malignancies. Other malignancies known to occur in the oesophagus include melanoma, sarcoma, and lymphoma. Among the sarcomas, carcinosarcoma is the commonest with both carcinomatous and sarcomatous elements followed by leiomyosarcoma of mesenchymal origin. Other sarcomas reported in the literature are liposarcoma, synovial sarcoma, myxofibrosarcoma, Ewing's sarcoma, granulocytic sarcoma, histiocytic sarcoma, schwannoma rhabdomyosarcoma, and epithelioid sarcoma. We report a case of malignant spindle cell tumour of oesophagus. Sarcomas of esophagus present as a polypoid exophytic soft tissue mass. Our patient presented with a stricture which is a rare presentation. Locally aggressive treatment with surgery is beneficial, and local palliative treatment including radiotherapy is worthwhile.
Collapse
|
16
|
Elmi M, Ko MA, Gupta A, Chung P, Keshavjee S. Primary tracheal Ewing's sarcoma. Ann Thorac Surg 2010; 90:1349-52. [PMID: 20868845 DOI: 10.1016/j.athoracsur.2010.02.109] [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] [Received: 10/31/2009] [Revised: 02/23/2010] [Accepted: 02/26/2010] [Indexed: 11/26/2022]
Abstract
Ewing's sarcoma is a malignant neoplasm usually occurring in the long and flat bones of children and adolescents. Extraskeletal Ewing's sarcoma is extremely rare, and we believe this has not been described previously in the trachea. We report a case of primary tracheal Extraskeletal Ewing's sarcoma that presented with acute airway obstruction. Stabilization of the airway was accomplished through a rigid bronchscopy, followed by debridement and stenting. The patient then underwent neoadjuvant chemotherapy followed by tracheal resection. Our case highlights the management of a tracheal mass and the multidisciplinary approach required for definitive treatment.
Collapse
Affiliation(s)
- Maryam Elmi
- Division of Thoracic Surgery, Toronto General Hospital and Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
17
|
Colovic RB, Grubor NM, Micev MT, Matic SV, Atkinson HDE, Latincic SM. Perigastric extraskeletal Ewing’s sarcoma: A case report. World J Gastroenterol 2009; 15:245-7. [PMID: 19132777 PMCID: PMC2653319 DOI: 10.3748/wjg.15.245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ewing’s sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES presenting with epigastric pain and weight loss. Ultrasound and computed tomography scans indicated a solid/cystic mass in the pancreatic tail. At laparotomy, the tumor was found attached to the posterior surface of the stomach, completely free from the pancreas, with no lymphadenopathy or local metastases. The polynodal, partly pseudocystic, dark-red soft tumor was excised. Histopathology revealed an anaplastic small-round-cell tumor with strong membranous CD99 immunoexpression. Additionally, there was patchy immunostaining for S-100 protein, vimentin, protein gene product (PGP) 9.5 and neuron-specific enolase, and weak focal CD117 cytoplasmic immunoreactivity. The patient had no adjuvant chemotherapy; her postoperative recovery was uneventful, and she remains symptom-free, and without any sign of recurrence at 20 mo. To the best of our knowledge, this is only the third ever case of gastric ES.
Collapse
|
18
|
Johnson AD, Pambuccian SE, Andrade RS, Dolan MM, Aslan DL. Ewing sarcoma and primitive neuroectodermal tumor of the esophagus: report of a case and review of literature. Int J Surg Pathol 2008; 18:388-93. [PMID: 18499684 DOI: 10.1177/1066896908316903] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study presents a case of Ewing sarcoma and primitive neuroectodermal tumor arising in the esophagus of a 44-year-old woman who presented with progressive dysphagia. Imaging studies demonstrated a polypoid lesion in the esophagus. The tumor was characterized by corded and pseudopapillary architecture, cytologic monotony, and low proliferative activity. Immunohistochemical stains were positive for CD99, neuron-specific enolase, vimentin, cyclin D1, p53, and FLI1 gene product. Fluorescence in situ hybridization demonstrated a 22q12 translocation, associated with primitive neuroectodermal tumor in the tumor cells, whereas reverse transcription polymerase chain reaction conformed expression of Ewing sarcoma/FLI1 fusion transcript in the patient's bone marrow aspirate. Although this is a rare site for this type of tumor to occur, primitive neuroectodermal tumor should be considered in the differential diagnosis of mesenchymal tumors of the esophagus. Genetic analysis is crucial to establish the diagnosis and can be successfully performed on formalin-fixed, paraffin-embedded material and hematopoietic tissue.
Collapse
Affiliation(s)
- Andrew D Johnson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | | | | |
Collapse
|
19
|
Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) of the penis. Int Urol Nephrol 2007; 40:113-5. [DOI: 10.1007/s11255-007-9202-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/28/2007] [Indexed: 10/22/2022]
|
20
|
García-Moreno Nisa F, López Quindos P, García Teruel D, Beni Pérez R. Extraosseous retroperitoneal Ewing's sarcoma. Clin Transl Oncol 2007; 9:404-5. [PMID: 17594956 DOI: 10.1007/s12094-007-0074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) belongs to the group of paediatric small round blue-cell tumours. ES/PNET is classically a tumour of the soft tissue or bone in children and young adults. The case of a 21-year-old woman with a retroperitoneal localisation of Ewing's sarcoma is described.
Collapse
Affiliation(s)
- F García-Moreno Nisa
- Departamento de Cirugia General y Digestiva, Hospital Ramón y Cajal, Madrid, Spain.
| | | | | | | |
Collapse
|
21
|
Ozturk E, Mutlu H, Sonmez G, Vardar Aker F, Cinar Basekim C, Kizilkaya E. Spinal epidural extraskeletal Ewing sarcoma. J Neuroradiol 2007; 34:63-7. [PMID: 17316801 DOI: 10.1016/j.neurad.2007.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A rare case of extraskeletal Ewing sarcoma, arising primarily in the spinal epidural space is reported. An 18-year-old male presented with a 2-month history of right shoulder pain progressing to complete paraplegia and urinary retention over the course of 2 days. Magnetic resonance imaging demonstrated an extradural mass extending from the C6 to T1 level. Histopathologic examination confirmed the diagnosis. The literature is reviewed and radiological differential diagnosis of this rare neoplasm is briefly discussed.
Collapse
Affiliation(s)
- E Ozturk
- Department of Radiology, GATA Haydarpasa Teaching Hospital, Egitim Hastanesi, Uskudar, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Mark Bernstein
- Service of Hematology/Oncology, Ste-Justine Hospital, University of Montreal, 3175 Cote Ste. Catherine Road, Montreal, Quebec, H3T 1C5, Canada.
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Ewing sarcoma/primitive neuroectodermal tumor is classically a tumor of the soft tissue or bone in children and young adults, but several cases have been described in patients of all ages. Within the last decade, the clinicopathologic spectrum of Ewing sarcoma/primitive neuroectodermal tumor has been markedly expanded by recognition that the tumor may also have a visceral origin. We describe a case of primitive neuroectodermal tumor arising in the stomach of a 66-year-old woman. The neoplasm was excised using a radical surgical procedure. Microscopically, the tumor was made up of solid nests and sheets of round cells. Immunohistochemically, the tumor cells showed immunoreactivity for CD99, S100, neuron-specific enolase, and vimentin. A multiplex real-time polymerase chain reaction assay detected an EWS-ERG fusion. To our knowledge, this is the first description of a primitive neuroectodermal tumor arising in the stomach.
Collapse
|
24
|
Abstract
Ewing sarcoma/primitive neuroectodermal tumor (ES/ PNET) most commonly occurs in the soft tissues of the extremities and the paravertebral areas. To our knowledge, no case of PNET has been reported in the gallbladder to date. We report a case of PNET of the gallbladder occurring in a 53-year-old woman. Microscopically, the monotonous small round cells with a formation of Homer-Wright rosettes showed intense membranous positive immunoreactivity for MIC2/CD99, as well as for neuron-specific enolase and synaptophysin. Other small round cell tumors, such as lymphoma, rhabdomyosarcoma, or melanoma, were excluded in light of negative immunoreactivity for leukocyte common antigen, desmin, and S100. The diagnosis of PNET was rendered based on the characteristic morphology and immunohistochemical findings, despite an absence of chromosomal translocations, such as t(11; 22)(q24;q12) and t(21;22)(q22;q12).
Collapse
Affiliation(s)
- Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|