1
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Wallace MW, Niec JA, Ghani MOA, McKay KG, Idrees K, Liang J, Borinstein SC, Lovvorn HN. Distribution and Surgical Management of Visceral Ewing Sarcoma Among Children and Adolescents. J Pediatr Surg 2023; 58:1727-1735. [PMID: 36774201 DOI: 10.1016/j.jpedsurg.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Ewing sarcoma (EWS) is a highly malignant tumor of bone and soft tissue that occasionally arises from viscera. Visceral EWS (V-EWS) is challenging to manage given its varied organ distribution and often late-stage presentation. We aimed to characterize our institutional experience with V-EWS, focusing on its surgical management, and to compare V-EWS outcomes against those with osseous (O-EWS) and soft tissue EWS (ST-EWS). METHODS Retrospective review of all EWS patients ≤21 years presenting to a single institution between 2000 and 2022. Patient- and disease-specific characteristics were compared. Overall and relapse-free survival were estimated using Kaplan Meier methods and log-rank test. RESULTS 156 EWS patients were identified: 117 O-EWS, 20 ST-EWS, and 19 V-EWS. V-EWS arose in the kidney (n = 5), lung (n = 5), intestine (n = 2), esophagus (n = 1), liver (n = 1), pancreas (n = 1), adrenal gland (n = 1), vagina (n = 1), brain (n = 1), and spinal cord (n = 1). No significant demographic differences were detected between EWS groups. V-EWS was more frequently metastatic at presentation (63.2%; p = 0.005), yet no significant overall or relapse-free survival differences emerged between EWS groups, with similar follow-up intervals. While V-EWS required multiple unique operative strategies to gain primary control, no significant difference in treatment strategies appeared between groups. Surgery-only primary control was associated with improved overall and relapse-free survival in all groups. CONCLUSIONS V-EWS presents unique management challenges in children and adolescents given its variable sites of origin. This large cohort is the first to describe the surgical management and outcomes of V-EWS, demonstrating more frequent metastatic presentation, while achieving similar survival across groups. LEVEL OF EVIDENCE Level 2 - Cohort Study.
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Affiliation(s)
| | - Jan A Niec
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Katlyn G McKay
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kamran Idrees
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott C Borinstein
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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2
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Valeri M, Dore L, Rudini N, Cieri M, Elefante GM, Saita A, Bertuzzi A, Colombo P. Case report: Primary Ewing sarcoma of the ureter, an exceptional finding of unique manifestation of disease. Front Oncol 2023; 12:1070838. [PMID: 36686730 PMCID: PMC9851605 DOI: 10.3389/fonc.2022.1070838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Ewing sarcoma (ES) is the second most common malignant bone tumor in children and has also been described in adults with highly aggressive behavior. ES belongs to the small round blue cell tumor family and presents the distinctive translocation of FET-ETS family genes (85% with EWSR1), generating gene fusions. Extraskeletal ES mainly occurs in soft tissues; the urogenital tract is rarely affected, and ureteral localization is an exceptional event with only 4 cases described in the literature. Here we report the first Italian case of primary ES of the ureter, a 24-year-old young man with lower back pain and a narrowed left ureteral lumen on CT scan. ES of the urogenital tract is an almost unique condition with a nonspecific clinical presentation and a challenging diagnosis for pathologists. We encourage awareness of these exceptional events in the differential diagnosis of ureteral lesions in young patients.
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Affiliation(s)
- Marina Valeri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Pathology, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Leocadia Dore
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Pathology, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Noemi Rudini
- Department of Pathology, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Miriam Cieri
- Department of Pathology, Humanitas Research Hospital, IRCCS, Milan, Italy
| | | | - Alberto Saita
- Department of Urology, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Alexia Bertuzzi
- Department of Oncology, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Pathology, Humanitas Research Hospital, IRCCS, Milan, Italy,*Correspondence: Piergiuseppe Colombo,
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3
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Li XX, Bi JB. Ureteral Ewing’s sarcoma in an elderly woman: A case report. World J Clin Cases 2019; 7:3372-3376. [PMID: 31667194 PMCID: PMC6819290 DOI: 10.12998/wjcc.v7.i20.3372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/22/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ewing’s sarcoma (ES) is regarded as a skeletal tumor, with few instances of extra-skeletal ES. A primary ES in the ureter is extremely rare.
CASE SUMMARY We report the case of a 69-year-old woman who presented with intermittent flank pain and hematuria and was found to have a mass in the left ureter. Pathology of the excised mass indicated ES. The clinical treatment and pathologic characteristics in this case, and a review of the literature describing ES in the urinary system, are presented.
CONCLUSION Due to the rarity and malignancy of ES in ureter, early diagnosis and prompt surgical treatment are critical.
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Affiliation(s)
- Xin-Xin Li
- Department of Urology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jian-Bin Bi
- Department of Urology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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4
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He Y, Sun N, Zhang W, Ma X, Ni X, Jin M, Sun J, Song H. Ewing sarcoma/primitive neuro-ectodermal tumor of the urogenital system in children: a retrospective observational case series. J Pediatr Urol 2019; 15:556.e1-556.e7. [PMID: 31377020 DOI: 10.1016/j.jpurol.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/27/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Pediatric Ewing sarcoma (ES)/primitive neuro-ectodermal tumor (PNET) occurring in the genitourinary system has been rarely reported. And the result of long-term follow-up is still a matter of debate. OBJECTIVE The aim of the study was to identify the characteristics, therapeutic strategies, and long-term outcomes of pediatric ES/PNET in the genitourinary system. PATIENTS AND METHODS All children with genitourinary system PNET from a single center were retrospectively reviewed. The American Joint Committee on Cancer (AJCC) staging system was used to evaluate tumor grade. RESULTS Four patients were included. Three were boys, and 1 was a girl. The locations of the lesions were the penis in 1 patient, ureter in 1 patient, and kidney in 2 patients. Two patients were of AJCC stage IVB, and the other 2 patients were of stage IIA. In the follow-up ranging from 2.5 to 8.0 years, 3 patients had survival, and 1 patient died. The patient with penis PNET survived during the 8 years of follow-up. One patient with renal PNET had tumor thromboses in the renal vein, inferior vena cava, and right atrium, which was the first definite report in children (case 3). DISCUSSION Primitive neuro-ectodermal tumor as a highly malignant subgroup of blue round cell tumor is extremely rare in the genitourinary system, especially in children. The current case series represents the first report of penis PNET in children with the longest (8 years) follow-up and first definite report of pediatric renal PNET with vena cava and atrium tumor thrombus. In contrast to the previous literature, the patient with ureteral PNET in this study was much younger, who was the youngest child to be reported in the literature thus far. Although the key prognostic factor of the outcomes is detectable metastases at diagnosis, the patient with penis PNET and bone and lung metastasis in this series still survived. It was hypothesized from the data of present cases that young age was a protective factor, which was consistent with the previous literature. Aggressive therapy is not trivial for patients with multiple recurrences who can also be a long-term survivor. The survival outcomes of these high-stage patients were favorable with combination treatment. As the patient with penis PNET in this series had bone metastasis at his 7.5 years after definite diagnosis, five years of follow-up was not enough. The follow-up period should be extended, even to a lifetime follow-up. CONCLUSIONS Children with PNET have a better prognosis than adults. Aggressive combination treatment should be performed to improve prognosis and the survival rate. It is better to monitor the changes of the disease by extending the follow-up period.
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Affiliation(s)
- Y He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - N Sun
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - W Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - X Ma
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Beijing, 100045, China
| | - X Ni
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - M Jin
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Beijing, 100045, China
| | - J Sun
- Imaging Center, Beijing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - H Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Shibuya S, Takamizawa S, Hatata T, Komori K, Ogiso Y, Yoshizawa K, Yoshizawa K. Extraosseous Ewing sarcoma in the mesentery: the first report of cases in children. Pediatr Surg Int 2015; 31:995-9. [PMID: 26280743 DOI: 10.1007/s00383-015-3782-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 12/23/2022]
Abstract
Extraosseous ewing sarcoma (EES) is a rare soft-tissue tumor usually found in the extremities or paraspinal region. We describe the case of a 4-year-old boy with a large cystic mass in the mesentery diagnosed as mesenteric lymphangioma preoperatively and as EES after partial resection and histopathological examination. EES in the mesentery is extremely rare, with only 2 reports described in the English literature. This represents the first report of EES in a child.
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Affiliation(s)
- Soichi Shibuya
- Departments of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino-shi, Nagano, 399-8288, Japan.
| | - Shigeru Takamizawa
- Departments of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino-shi, Nagano, 399-8288, Japan
| | - Tomoko Hatata
- Departments of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino-shi, Nagano, 399-8288, Japan
| | - Kazutoshi Komori
- Departments of Oncology, Nagano Children's Hospital, Nagano, Japan
| | - Yoshifumi Ogiso
- Departments of Pathology, Nagano Children's Hospital, Nagano, Japan
| | - Katsumi Yoshizawa
- Departments of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino-shi, Nagano, 399-8288, Japan
| | - Kazuki Yoshizawa
- Departments of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino-shi, Nagano, 399-8288, Japan
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Bianchi D, Vespasiani G, Bove P. Acute kidney injury due to bilateral ureteral obstruction in children. World J Nephrol 2014; 3:182-192. [PMID: 25374811 PMCID: PMC4220350 DOI: 10.5527/wjn.v3.i4.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/28/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.
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7
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Primary peripheral primitive neuroectodermal tumor/Ewing's tumor of the testis in a 46-year-old man—differential diagnosis and review of the literature. Hum Pathol 2009; 40:893-7. [DOI: 10.1016/j.humpath.2008.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 11/07/2008] [Accepted: 11/10/2008] [Indexed: 12/22/2022]
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8
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Ammani A, Ghadouane M, Hajji F, Janane A, Ameur A, Abbar M. [Primitive neuroectodermal tumor (PNET) of the upper-urinary tract]. Prog Urol 2009; 19:579-81. [PMID: 19699458 DOI: 10.1016/j.purol.2009.02.007] [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] [Received: 12/30/2008] [Revised: 02/17/2009] [Accepted: 02/18/2009] [Indexed: 12/23/2022]
Abstract
Primitive neuroectodermal tumors (PNETs) are rare and aggressive malignant small round cell sarcomas. Primitive urogenital location of PNETs is rare and occurs most frequently in the kidney. PNETs of the upper-urinary tract are exceptional (only one case reported in the literature). Its diagnosis is almost postoperative within pathological study of the operatory specimen, supported by immunohistochemistry and cytogenetics. Treatment is similar in all to that of Ewing's sarcoma and involves surgery, chemotherapy and radiotherapy. We report a new case of upper-urinary tract PNET and discuss the diagnostic and therapeutic problems posed by this particular tumor.
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Affiliation(s)
- A Ammani
- Service d'urologie, hôpital militaire d'instruction Mohammed-V, Hay-Riad, 10101 Rabat, Maroc.
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9
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Al-Najar A, Siggelkow M, Naumann CM, Hamann MF, Jünemann PK, van der Horst C. Ewing's sarcoma of the urogenital tract. Int Urol Nephrol 2008; 41:13-7. [PMID: 18574704 DOI: 10.1007/s11255-008-9415-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 06/02/2008] [Indexed: 11/25/2022]
Abstract
This article reviews the current available information on Ewing's sarcoma of the urogenital tract, focusing on the presentation, diagnosis, and therapeutic management of this uncommon entity. Because of the rapid local growth of these tumors, an immediate decision for treatment initiation is mandatory. The classical presentation depends mainly on the site of involvement of these tumors, involving a palpable mass, hematuria, and pain. No specific diagnostic imaging is available to date, and the only diagnostic method remains histological examination in combination with immunohistochemistry. Treatment involves primary surgical resection of all tumor tissues followed by adjuvant multi-agent chemotherapy. Overall survival is poor, although a 13-year survival has been reached in one case.
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Affiliation(s)
- Amr Al-Najar
- Department of Urology and Paediatric Urology, Schleswig Holstein, Campus Kiel, Kiel, Germany.
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10
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Neoplasms of the upper urinary tract: a review with focus on urothelial carcinoma of the pelvicalyceal system and aspects related to its diagnosis and reporting. Adv Anat Pathol 2008; 15:127-39. [PMID: 18434765 DOI: 10.1097/pap.0b013e31817145a9] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumors of the renal pelvis account for approximately 7% to 8% of all renal malignancies, greater than 90% of these are of urothelial (transitional cell) origin. These tumors more typically occur in the sixth to eight decade with a slight male preponderance. Varying risk factors for urothelial carcinomas of the upper tract are recognized including environmental and occupational hazards, chemotherapeutic exposure, and previous history of urinary bladder or ureteral carcinomas. Tumor multifocality is frequent and additional tumors may arise in the ureter, bladder, or on the contralateral side. The histopathologic nuances presented by urothelial carcinoma in this region are generally similar to those in the urinary bladder. Though the World Health Organization 2004/International Society of Urological Pathology system used in the bladder is customarily also employed for grading of urothelial tumors of this region, its prognostic significance at this site is not entirely clear as most tumors are treated with nephroureterectomy irrespective of the grade of the tumor. Histologic grade may be an independent prognostic factor in papillary pT1 tumors; however, most pT2 and higher stage tumors tend to be nonpapillary and of higher grade. Despite advances in treatment modalities with sophisticated endoscopic techniques, tumor stage remains the most important prognostic factor. There are several confounding issues related to staging such as the variable presence and thickness of subepithelial connective tissue and muscularis in the renal calyces, renal pelvis, and the ureter; intratubular pagetoid cancer spread (pTis vs. pT3); and assessing invasion in papillary neoplasms with endophytic or inverted growth. Careful gross examination with adequate sampling and understanding the microanatomy of the pelvicalyceal wall are crucial for accurate stage assignment. Poor fixation of large friable tumors and processing artifacts may compound difficulties in accurate staging. This review focuses on urothelial carcinoma of the upper tract highlighting issues related to its diagnosis, staging, and reporting.
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11
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Thete N, Rastogi D, Arya S, Singh A, Rao P, Chandge A, Ramadwar M. Primitive neuroectodermal tumour of the prostate gland: ultrasound and MRI findings. Br J Radiol 2007; 80:e180-3. [PMID: 17762052 DOI: 10.1259/bjr/57293350] [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: 12/19/2022] Open
Abstract
We report a rare case of primitive neuroectodermal tumour (PNET) of the prostate occurring in a 26-year-old man with a mass replacing the prostate gland in the absence of any lesion involving the bone and soft tissues. To our knowledge, there is no radiological literature that has described the imaging findings in a case of PNET of the prostate. Imaging findings in cases of PNET of the kidney are described in the literature. On ultrasound, the mass appeared multilobulated and multinodular with intratumoural heterogeneity. No brightly reflective echoes with posterior acoustic shadowing to suggest calcification were noted. MRI revealed a heterogeneous lobulated mass with irregular septae within. The mass showed low signal intensity on T(1) weighted images and appeared heterogeneous on T(2) weighted images. Haemorrhage and necrosis were also seen in the tumour.
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Affiliation(s)
- N Thete
- Tata Memorial Hospital, Ernest Borges Road, Parel, Mumbai-400012, Maharashtra, India.
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12
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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.
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Affiliation(s)
- F García-Moreno Nisa
- Departamento de Cirugia General y Digestiva, Hospital Ramón y Cajal, Madrid, Spain.
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13
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Ellinger J, Bastian PJ, Hauser S, Biermann K, Müller SC. Primitive neuroectodermal tumor: rare, highly aggressive differential diagnosis in urologic malignancies. Urology 2006; 68:257-62. [PMID: 16904430 DOI: 10.1016/j.urology.2006.02.037] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 01/06/2006] [Accepted: 02/21/2006] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Peripheral primitive neuroectodermal tumor (PNET) is a highly aggressive neoplasm belonging to the Ewing family of tumors. It is characterized by the expression of MIC2 and neural markers (eg, neuron-specific enolase, synaptophysin, S-100, vimentin, Leu-7), and the presence of the EWS-FLI1 translocation. METHODS We performed a MEDLINE search for PNET in urologic malignancies. Additionally, we report on 2 cases of renal and 1 case of bladder PNET. The data obtained by reviewing patients with renal PNET were analyzed using Kaplan-Meier analysis. RESULTS Renal PNET is diagnosed in young adults (median age 24 years). In contrast, the incidence of bladder PNET seems to be dependent on a defective immune mechanism. Patients often present with pain (84%), palpable tumor (60%), and hematuria (38%). The radiologic findings are uncharacteristic; therefore, the diagnosis should be based on the histologic and immunohistochemistry findings. Renal and bladder PNET are both often diagnosed at an advanced stage and, therefore, the prognosis is poor, despite aggressive multimodal treatment (surgery, polychemotherapy, radiotherapy). We identified palpable tumor masses (log-rank test, P = 0.0027) and synaptophysin expression (log-rank test, P = 0.0422) as prognostic unfavorable markers for renal PNET. CONCLUSIONS Renal PNET should be considered in young patients who present with the classic triad of renal cancer, hematuria, and pain and palpable tumor. Once PNET is diagnosed, multimodal treatment (radical surgery, multidrug chemotherapy, radiotherapy) must be initiated. Despite this, the prognosis is poor if distant metastases are present. Furthermore, palpable tumor masses and synaptophysin expression are associated with a shorter cancer-specific survival.
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Affiliation(s)
- Jörg Ellinger
- Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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14
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Abstract
Extraosseous Ewing's sarcoma of the vulva is extremely rare with only three such cases described. A 26-year-old woman presented with Ewing's sarcoma of the vulva. She received chemotherapy to shrink the lesion. However, the response was suboptimal and she subsequently received radiotherapy. Although resection was planned, she developed chest metastases within a short period of time and subsequently died.
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Affiliation(s)
- M Moodley
- Gynaecology Oncology, Subdivision of the Department of Obstetrics & Gynaecology and Department of Radiation Oncology, Nelson R. Mandela School of Medicine, Durban, South Africa
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15
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Strefford JC, Lane TM, Hill A, LeRoux L, Foot NJ, Shipley J, Oliver RTD, Lu YJ, Young BD. Molecular characterisation of the t(1;15)(p22;q22) translocation in the prostate cancer cell line LNCaP. Cytogenet Genome Res 2006; 112:45-52. [PMID: 16276089 DOI: 10.1159/000087512] [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] [Received: 11/09/2004] [Accepted: 04/27/2005] [Indexed: 02/04/2023] Open
Abstract
Although chromosome translocations are well-documented recurrent events in hematological malignancies and soft tissue sarcomas, their significance in carcinomas is less clear. We report here the molecular characterization of the reciprocal translocation t(1;15)(p22;q22) in the prostate carcinoma cell line, LNCaP. The chromosome 1 breakpoint was localized to a single BAC clone, RP11-290M5, by sequential FISH analysis of clones selected from the NCBI chromosome 1 map. This was further refined to a 580-bp region by Southern blot analysis. A 2.85-kb fragment spanning the der(1) breakpoint was amplified by long-range inverse PCR. The breakpoint on chromosome 1 was shown to lie between the CYR61 and the DDAH1 genes with the der(1) junctional sequence linking the CYR61 gene to the TSPAN3 (TM4SF8) gene on chromosome 15. Confirmatory PCR and FISH mapping of the der(15) showed loss of chromosome material proximal to the breakpoint on chromosome 15, containing the PSTPIP1 and RCN2 genes. On the available evidence we conclude that this translocation does not result in an in-frame gene fusion. Comparative expressed sequence hybridization (CESH) and comparative genomic hybridization (CGH) analysis, showed relative down-regulation of gene expression surrounding the breakpoint, but no gross change in genomic copy number. Real-time quantitative RT-PCR for genes around the breakpoint supported the CESH data. Therefore, here we may have revealed a gene down-regulation mechanism associated with a chromosome translocation, either through small deletion at the breakpoint or through another means of chromosome domain related gene regulation.
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Affiliation(s)
- J C Strefford
- Cancer Research UK Medical Oncology Unit, Queen Mary and Westfield College, Charterhouse Square, London, UK.
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Taylor M, Guillon M, Champion V, Marcu M, Arnoux JB, Hartmann O. La tumeur d'Ewing. Arch Pediatr 2005; 12:1383-91. [PMID: 16046110 DOI: 10.1016/j.arcped.2005.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 05/24/2005] [Indexed: 11/16/2022]
Abstract
Ewing's tumor (ET) is a malignant bone tumor occurring in children and young adults. ET affects mainly bones of the central axis, and almost always involves soft tissue infiltration. The discovery of a unique genetic alteration, which is a reciprocal translocation most frequently resulting in the fusion of the EWS gene situated on chromosome 22 with the FLI-1 gene on chromosome 11, currently places ET among neuroectodermal tumors. Moreover, this translocation is a tumor-specific genetic marker at the basis of defining ET today and is used as a diagnostic and potentially prognostic tool complementary to imaging and histopathological work-up. Since the 1970 s, important progress has been made in the clinical management of ET patients. Multiagent chemotherapy in association with local treatment (surgery and/or radiation) has clearly improved outcome. The introduction of systemic treatment was justified by the frequent sub-clinical diffusion of apparently localized ET. Intensified therapeutic strategies have for the first time cured some metastatic ET patients, but at the cost of major side effects. Treatment is currently adapted as a result of a better definition of prognostic factors as well as a better assessment of its adverse effects. Improvement in global patient care and increased management of specific acute complications associated with ET (often interwoven with iatrogeneous effects) represent an important step towards improving the quality of life for ET patients as well as preventing long term complications. In the light of present studies, the majority of surviving adults today describe their health and quality of life as good. ET is a fascinating example of the progress made not only in the diagnostic and therapeutic approach to cancer but also in the comprehension of the mechanisms behind carcinogenesis, and consequently reflects the revolution of medicine over the last century.
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Affiliation(s)
- M Taylor
- Service d'oncologie pédiatrique, institut Gustave-Roussy, rue Camille-Desmoulins, 94805 Villejuif, France
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Vardy J, Joshua AM, Clarke SJ, Yarrow PM, Lin BPC. Small blue cell tumors of the rectum. Case 1. Ewing's sarcoma of the rectum. J Clin Oncol 2005; 23:910-2. [PMID: 15681537 DOI: 10.1200/jco.2005.03.096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- J Vardy
- Department of Medical Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia
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Colecchia M, Dagrada G, Poliani PL, Messina A, Pilotti S. Primary primitive peripheral neuroectodermal tumor of the prostate. Immunophenotypic and molecular study of a case. Arch Pathol Lab Med 2003; 127:e190-3. [PMID: 12683899 DOI: 10.5858/2003-127-e190-pppnto] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A case of primitive peripheral neuroectodermal tumor arising in the prostate gland of a 31-year-old man and first diagnosed through a biopsy is reported. Microscopically, the tumor was made up of solid nests and sheets of small round cells, and it was difficult to distinguish the neoplasm from other small round cell tumors, such as small cell carcinoma, rhabdomyosarcoma, or malignant lymphoma. Immunohistochemically, the tumor cells showed immunoreactivity for CD99, vimentin, neuron-specific enolase, and synaptophysin. The neoplasm was excised by a radical surgical procedure preceded by chemotherapy and radiation therapy. The morphologic diagnosis of the prostatectomy specimen was complemented by molecular analysis performed on viable microdissected tissue obtained from formalin-fixed, paraffin-embedded tumor sections. Polymerase chain reaction and sequencing assessment showed the presence of EWS/FLI1 type 2 chimeric transcript, confirming the diagnosis of peripheral primitive neuroectodermal tumor. To our knowledge, this is the first description of a primary peripheral primitive neuroectodermal tumor in the prostate gland.
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MESH Headings
- Adult
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Cytogenetic Analysis/methods
- Genes, Neoplasm/genetics
- Humans
- Immunophenotyping/methods
- Male
- Neuroectodermal Tumors, Primitive, Peripheral/chemistry
- Neuroectodermal Tumors, Primitive, Peripheral/diagnosis
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Oncogene Proteins, Fusion/genetics
- Prostatic Neoplasms/chemistry
- Prostatic Neoplasms/diagnosis
- Prostatic Neoplasms/genetics
- Proto-Oncogene Protein c-fli-1
- RNA-Binding Protein EWS
- Transcription Factors/genetics
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Affiliation(s)
- Maurizio Colecchia
- Dipartimento di Patologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
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