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Cherraqi A, El Mandour J, Dghoughi B, Tbouda M, El Kababri M, Hessissen L, El Haddad S, Allali N, Chat L. A rare case of Ewing's sarcoma of the maxillary sinus. Radiol Case Rep 2023; 18:4248-4252. [PMID: 37766835 PMCID: PMC10520663 DOI: 10.1016/j.radcr.2023.08.095] [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: 07/13/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Ewing's sarcoma is generally an aggressive, poorly differentiated bone and soft tissue tumor affecting children and young adults, it accounts for 4%-6% of all primary bone tumors and primary facial locations occur in only 1%-4% of all cases, primarily in the mandible and calvaria. Involvement of the paranasal sinuses is rare. Here we report the case of an 11-year-old girl with no medical, surgical, or traumatic history, who presented for 1 month and progressive evolution of swelling of the left cheek, associated with pain, nasal obstruction, rhinorrhea, and a slight weight loss not quantified. A craniofacial computed tomography (CT) scan showed a mixed lytic and condensing lesional tissue process centered on the left maxillary sinus, heterogeneously enhanced after contrast injection, lysing the walls of the sinus extended to the homolateral nasal cavity and slightly infiltrating the adjacent soft tissues. An incisional biopsy was performed and the pathological study proved that it was Ewing's sarcoma. She was put on neoadjuvant chemotherapy using 6 courses of vincristine, doxorubicin, ifosfamide, etoposide which resulted in a partial regression of the tumor size by 50%. Then the patient was put on combined chemotherapy and radiotherapy. A follow-up CT scan after 6 courses of vincristine, actinomycin, cyclophosphamide, and 17 sessions of radiotherapy showed lesion stability. Maxillary Ewing's sarcoma is a rare and aggressive tumor. Therefore, early diagnosis, combination therapy, and long-term follow-up are suggested in such cases to improve the survival rate.
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Affiliation(s)
- Amine Cherraqi
- Radiology Department Mother and Child Hospital Ibn Sina, Rabat, Morocco
| | - Jihane El Mandour
- Radiology Department Mother and Child Hospital Ibn Sina, Rabat, Morocco
| | - Basma Dghoughi
- Radiology Department Mother and Child Hospital Ibn Sina, Rabat, Morocco
| | - Mohammed Tbouda
- Anatomical Pathology Department, Mohammed Vth military hospital, Rabat, Morocco
| | - Maria El Kababri
- Pediatric Oncology Department, Mother and Child Unit, CHU Ibn Sina Rabat, Morocco
| | - Laila Hessissen
- Pediatric Oncology Department, Mother and Child Unit, CHU Ibn Sina Rabat, Morocco
| | - Siham El Haddad
- Radiology Department Mother and Child Hospital Ibn Sina, Rabat, Morocco
| | - Nazik Allali
- Radiology Department Mother and Child Hospital Ibn Sina, Rabat, Morocco
| | - Latifa Chat
- Radiology Department Mother and Child Hospital Ibn Sina, Rabat, Morocco
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2
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Sileo G, Valentini M, Gravante G, Monti G, Arosio AD, Bignami M, Battaglia P, Castelnuovo P, Turri-Zanoni M. Sinonasal Malignancies Involving the Frontal Sinus: A Mono-Institutional Experience of 84 Cases and Systematic Literature Review. J Clin Med 2023; 12:jcm12093186. [PMID: 37176626 PMCID: PMC10179019 DOI: 10.3390/jcm12093186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Frontal sinus involvement by malignant tumors is a rare finding. Therefore, a systematic literature review along with a personal case series may contribute to defining more accurately the epidemiology, treatment options, and outcomes of these neoplasms. This is a retrospective review of patients affected by frontal sinus malignancies surgically treated in a tertiary-care referral center over a period of 20 years. Moreover, a systematic literature review of studies describing frontal sinus cancers from 2000 to date was performed according to PRISMA guidelines in order to analyze current evidence about the treatment and outcomes of such a rare disease. Our retrospective review was basedon 84 cases, treated with an exclusive endoscopic approach in 43 cases (51.2%), endoscopic approach with frontal osteoplastic flap in 6 cases (7.1%), and transfacial or transcranial approaches in 35 cases (41.7%). The five-year overall, disease-specific, disease-free, and recurrence-free survivals were 54.6%, 62.6%, 33.1%, and 59.1%, respectively. Age, dural involvement, type of surgical resection, and surgical margin status were significantly associated with the survival endpoints. In conclusion, the involvement of the frontal sinus is associated with a poor prognosis. Multidisciplinary management, including specific histology-driven treatments, represents the gold standard for improving outcomes and minimizing morbidity.
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Affiliation(s)
- Giorgio Sileo
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Marco Valentini
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Giacomo Gravante
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Giulia Monti
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Alberto D Arosio
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Maurizio Bignami
- Department of Otolaryngology Head and Neck Surgery, ASST Lariana, Ospedale Sant'Anna, University of Insubria, 22042 Como, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Paolo Battaglia
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | - Mario Turri-Zanoni
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
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3
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Kasturi N, Sarkar S, Gokhale T, Ganesh RN. Primary Ewing's sarcoma of the ethmoid sinus with orbital extension in a young child: A rare case and review of literature. Indian J Ophthalmol 2022; 70:2741-2744. [PMID: 35791231 PMCID: PMC9426177 DOI: 10.4103/ijo.ijo_236_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Sandip Sarkar
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Rajesh Nachiappa Ganesh
- Department of Pathology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
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4
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A review of nasal, paranasal, and skull base tumors invading the orbit. Surv Ophthalmol 2017; 63:389-405. [PMID: 28739401 DOI: 10.1016/j.survophthal.2017.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
Abstract
Tumors that invade the orbit are uncommon. The majority are meningiomas arising from the sphenoid ridge (66%). Others are bone and cartilage tumors arising from the surrounding bones of the orbit, pituitary adenomas, and epithelial tumors arising from the paranasal sinuses and nasal cavity. Meningiomas occur more often in women, whereas epithelial tumors have a predilection for men. Meningiomas and epithelial tumors typically present in the sixth decade of life, whereas bone tumors tend to affect individuals in their third decade of life. Patients often present with a combination of ophthalmological and otorhinolaryngological symptoms, including proptosis, pain, decreased visual acuity, restrictions in motility of the eye, epistaxis, and nasal obstruction. Sarcomas and benign bone and cartilage tumors arise from surrounding structures, whereas carcinomas usually arise from the paranasal sinuses. Surgery is the mainstay of treatment. Depending on the aggressiveness and histology of the tumor, surgery may be combined with radiation and chemotherapy. The prognosis is generally poor, but varies depending on histology and cell origin, size of the tumor, and degree of invasion. Meningiomas and benign bone tumors have the best prognoses. Sinonasal undifferentiated carcinomas, small-cell neuroendocrine carcinomas, osteosarcomas, and rhabdomyosarcomas have poorer prognoses.
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Abstract
The extra-skeletal form is an unusual type of Ewing sarcoma (ES) arising from soft tissue and in the literature there are reports of less than 50 patients describing the tumor in the paranasal sinuses and skull base. The histological diagnosis is crucial to plan the correct treatment and the molecular confirmation is mandatory in equivocal patients. A multimodality treatment with chemotherapy, surgery and radiotherapy improved the outcomes of these diseases during the last decades and a free-margin resection with the endoscopic transnasal technique is one of the most recent ways to manage these pathologies in selected patients, reducing the morbidities of the external approaches and preserving the quality of life of the patient.Here, the authors present the first patient of primary sinonasal ES free from disease after 5 years of follow-up and treated with an endoscopic endonasal approach and a second patient of sinonasal metastases of ES treated with and endoscopic transnasal approach.
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Lombardi D, Mattavelli D, Redaelli De Zinis LO, Accorona R, Morassi ML, Facchetti F, Ferrari V, Farina D, Bertulli R, Nicolai P. Primary Ewing's sarcoma of the sinonasal tract in adults: A challenging disease. Head Neck 2016; 39:E45-E50. [PMID: 27898190 DOI: 10.1002/hed.24649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/19/2016] [Accepted: 10/21/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sinonasal localization of Ewing's sarcoma in adults is an exceedingly rare event. METHODS The clinical records of 5 patients with primary sinonasal Ewing's sarcoma treated from 1992 to 2012 were retrospectively analyzed. All pathologic slides were reviewed by 2 experienced pathologists. All patients underwent multimodality treatments. RESULTS Median age was 36 years (range, 25-52 years). At referral, 2 patients had the original diagnosis changed by review of the histologic slides. Tumors were classified as T4aN0M0 (4 patients) and T2N0M0 (1 patient). Median follow-up was 110 months (range, 70-139 months). Only 1 patient, who started treatment elsewhere based on an incorrect histologic diagnosis, experienced multiple recurrences and eventually died of widespread metastasis. CONCLUSION Correct pathologic diagnosis can have a crucial impact on treatment planning and outcome. Multimodality therapy is the key for long-term successful results. Because of the rarity of the tumor, referral to highly experienced care centers is strongly recommended. © 2016 Wiley Periodicals, Inc. Head Neck 39: E45-E50, 2017.
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Affiliation(s)
- Davide Lombardi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca O Redaelli De Zinis
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Remo Accorona
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maria L Morassi
- Unit of Pathology, Department of Translational and Molecular Medicine, University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- Unit of Pathology, Department of Translational and Molecular Medicine, University of Brescia, Brescia, Italy
| | - Vittorio Ferrari
- Unit of Medical Oncology, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Rossella Bertulli
- Adult Mesenchymal Tumor Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Yaprak N, Toru HS, Ozbudak IH, Derin AT. Primary extraskeletal Ewing's sarcoma of the maxillary sinus. Braz J Otorhinolaryngol 2016; 85:538-541. [PMID: 27177977 PMCID: PMC9443039 DOI: 10.1016/j.bjorl.2016.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/26/2016] [Accepted: 03/31/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Neslihan Yaprak
- Akdeniz University, School of Medicine, Department of Otorhinolaryngology, Antalya, Turkey.
| | - Havva Serap Toru
- Akdeniz University, School of Medicine, Department of Pathology, Antalya, Turkey
| | - Irem Hicran Ozbudak
- Akdeniz University, School of Medicine, Department of Pathology, Antalya, Turkey
| | - Alper Tunga Derin
- Akdeniz University, School of Medicine, Department of Otorhinolaryngology, Antalya, Turkey
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8
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Kabarriti R, Mark D, Fox J, Kalnicki S, Garg M. Proton therapy for the treatment of pediatric head and neck cancers: A review. Int J Pediatr Otorhinolaryngol 2015; 79:1995-2002. [PMID: 26644365 DOI: 10.1016/j.ijporl.2015.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111E 210th Street, Bronx, NY 10467, United States
| | - Daniel Mark
- Radiation Oncology, NS-LIJ Medical Center, 450 Lakeville Road, Lake Success, NY 11042, United States
| | - Jana Fox
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111E 210th Street, Bronx, NY 10467, United States
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111E 210th Street, Bronx, NY 10467, United States
| | - Madhur Garg
- Department of Radiation Oncology and Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine, 111E 210th Street, Bronx, NY 10467, United States.
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Abstract
Sarcomas are a heterogeneous group of tumors that can occur in a wide array of anatomic sites and age ranges with varying histologies. Proton beam therapy, as compared with advanced x-ray radiation therapy techniques, can substantially lower dose to nontarget tissues. This dosimetric advantage can potentially allow for improvement of the therapeutic ratio in the treatment of many of the sarcomas by either increasing the local control, via increased dose to the target, or by decreasing the normal tissue complications, via lowered dose to the avoidance structures. This article reviews the key dosimetric studies and clinical outcomes published to date documenting the potential role proton beam therapy may play in the treatment of sarcomas.
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10
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11
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Wang D, Guo Z. Multiple primary Ewing's sarcomas in cerebral cranium of a child: a case report and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:7575-7582. [PMID: 26261672 PMCID: PMC4526006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
Ewing's sarcoma is the second most common pediatric bone tumor. Primary Ewing's sarcoma occurring in the cerebral cranium is exceptionally rare, with only one reported case of multiple tumor lesions in adolescence to date. We report a case of a 5-year-old male patient with multiple primary Ewing's sarcomas associated with the cranial bones, the first pediatric case report to date. We also review 71 cases Ewing's sarcoma involving intracranial extension. The purpose of this article is to provide data concerning the clinical and therapeutic course of multiple primary Ewing's sarcomas in associated with cerebral cranium.
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Affiliation(s)
- Dawei Wang
- Department of Neurosurgery, 1st Hospital of China Medical UniversityShenyang, People’s Republic of China
- Department of Neurosurgery, Benxi Central HospitalBenxi, People’s Republic of China
| | - Zongze Guo
- Department of Neurosurgery, 1st Hospital of China Medical UniversityShenyang, People’s Republic of China
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12
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Proton radiotherapy for pediatric sarcoma. Cancers (Basel) 2014; 6:112-27. [PMID: 24424260 PMCID: PMC3980591 DOI: 10.3390/cancers6010112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022] Open
Abstract
Pediatric sarcomas represent a distinct group of pathologies, with approximately 900 new cases per year in the United States alone. Radiotherapy plays an integral role in the local control of these tumors, which often arise adjacent to critical structures and growing organs. The physical properties of proton beam radiotherapy provide a distinct advantage over standard photon radiation by eliminating excess dose deposited beyond the target volume, thereby reducing both the dose of radiation delivered to non-target structures as well as the total radiation dose delivered to a patient. Dosimetric studies comparing proton plans to IMRT and 3D conformal radiation have demonstrated the superiority of protons in numerous pediatric malignancies and data on long-term clinical outcomes and toxicity is emerging. In this article, we review the existing clinical and dosimetric data regarding the use of proton beam radiation in malignant bone and soft tissue sarcomas.
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13
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Li M, Hoschar AP, Budd GT, Chao ST, Scharpf J. Primary Ewing's sarcoma of the ethmoid sinus with intracranial and orbital extension: case report and literature review. Am J Otolaryngol 2013; 34:563-8. [PMID: 23706594 DOI: 10.1016/j.amjoto.2013.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
The Ewing's sarcoma family of tumors is a group of cancers that commonly arises in young adults during their second decade of life. It frequently involves the trunk and long bones of the body with primary Ewing's sarcoma of the paranasal sinuses being exceedingly rare. We describe the case of a 39 year-old female with primary Ewing's Sarcoma originating from the ethmoid sinus with intracranial extension into the anterior cranial fossa and the orbit. The radiologic and histopathologic profiles are presented with a review of the literature. To our knowledge, this is the second reported case with the tumor involving the anterior cranial fossa, but the only case where immunochemical staining and molecular genetic analysis are available for definitive diagnosis.
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14
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Meccariello G, Merks JHM, Pieters BR, van Furth WR, Saeed P, Schoot RA, Freling NJM, Bras J, Strackee SD, Balm AJM, Georgalas C. Endoscopic management of Ewing's sarcoma of ethmoid sinus within the AMORE framework: a new paradigm. Int J Pediatr Otorhinolaryngol 2013; 77:139-43. [PMID: 23047066 DOI: 10.1016/j.ijporl.2012.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
The Ablative surgery, MOulage brachytherapy and REconstruction) (AMORE) protocol developed in the Academic Medical Center of Amsterdam has been used successfully to treat sarcomas. The use of endoscopic surgery fits well within this framework. A 6-year-old boy presented with Ewing Sarcoma of left ethmoid sinus closest to orbit. The patient underwent neoadjuvant chemotherapy followed by complete endoscopic resection, brachytherapy and reconstruction. Brachytherapy was administered by iridium catheters through limited Lynch-Howarth incision. Skull base defect was reconstructed with a galea flap. The use of endoscopic surgery complemented by neoadjuvant chemotherapy and brachytherapy might maximize tumor control while reducing morbidity.
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Affiliation(s)
- Giuseppe Meccariello
- Academic Clinic of Otolaryngology and Head-Neck Surgery, Department of Surgical Sciences, University of Florence, Florence, Italy
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Abstract
The increasing efficacy of pediatric cancer therapy over the past four decades has produced many long-term survivors that now struggle with serious treatment related morbidities affecting their quality of life. Radiation therapy is responsible for a significant proportion of these late effects, but a relatively new and emerging modality, proton radiotherapy hold great promise to drastically reduce these treatment related late effects in long term survivors by sparing dose to normal tissues. Dosimetric studies of proton radiotherapy compared with best available photon based treatment show significant dose sparing to developing normal tissues. Furthermore, clinical data are now emerging that begin to quantify the benefit in decreased late treatment effects while maintaining excellent cancer control rates.
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Affiliation(s)
- Shane E Cotter
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA 02115, USA
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16
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Ibrahim GM, Fallah A, Shahideh M, Tabori U, Rutka JT. Primary Ewing's sarcoma affecting the central nervous system: a review and proposed prognostic considerations. J Clin Neurosci 2011; 19:203-9. [PMID: 22024233 DOI: 10.1016/j.jocn.2011.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/21/2011] [Indexed: 10/15/2022]
Abstract
Ewing's sarcoma (ES) is a part of a larger family of round blue cell tumors, which occasionally manifest as osseous or extraosseous lesions adjacent to or within the central nervous system (CNS). While a large body of literature exists on ES of bone, data are lacking on tumors with cranial or spinal components that affect the CNS. Here, we perform a systematic review of the literature and summarize the best available evidence on diagnosis, treatment and outcomes of ES affecting the CNS with emphasis on the breadth of clinical presentations, diagnostic tools and emerging management options for these rare and challenging lesions. We include a review of known prognostic factors and propose several new considerations for prognostication of ES affecting the CNS.
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Affiliation(s)
- George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Suite 1503, 555 University Avenue, Toronto, Ontario M5G 1X9, Canada.
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17
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Hafezi S, Seethala RR, Stelow EB, Mills SE, Leong IT, MacDuff E, Hunt JL, Perez-Ordoñez B, Weinreb I. Ewing's family of tumors of the sinonasal tract and maxillary bone. Head Neck Pathol 2010; 5:8-16. [PMID: 21107767 PMCID: PMC3037459 DOI: 10.1007/s12105-010-0227-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
The Ewing's family of tumors (EFT) are malignant neoplasms affecting children and young adults. Most cases arise in the long bones or the pelvis. Primary EFT of head and neck is uncommon and primary sinonasal EFT is even rarer. Previous studies have not focused on the sinonasal region specifically, and the published literature on sinonasal EFT consists of sporadic case reports. Fourteen cases of sinonasal EFT were available and had H&Es for review and immunohistochemical stains for CD99, S100, keratins, synaptophysin and desmin. FISH or RT-PCR was performed for EWSR1 abnormalities on 8 cases. The 14 identified patients included 5 males and 9 females, ranging from 7-70 years of age (mean 32.4 years). Tumors involved nasal cavity (5), sinuses (5) or both (4). Five patients had dural, orbital or brain involvement. The majority involved bone radiologically and/or microscopically. All cases were composed of small cells with variable cytoplasmic clearing. Focal or prominent nesting was noted in most cases. All cases were positive for CD99. Keratins (AE1/3 and/or CAM5.2), S100 and synaptophysin were positive in 4, 3 and 5 cases, respectively. All cases were negative for desmin. The 8 cases tested by FISH or RT-PCR were positive for EWSR1 abnormalities. Follow-up in 8 patients ranged from 1-168 months (average 11.3 m) showing 1 death due to metastatic disease, 1 death due to local disease, 1 patient alive with metastases and 5 patients disease-free at last follow-up. Interestingly, however, an analysis of the literature suggests a better prognosis for sinonasal EFT than EFT overall.
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Affiliation(s)
- Sara Hafezi
- Department of Pathology, University Health Network, Toronto, ON Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Raja R. Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Edward B. Stelow
- Department of Pathology, University of Virginia, Charlottesville, VA USA
| | - Stacey E. Mills
- Department of Pathology, University of Virginia, Charlottesville, VA USA
| | - Iona T. Leong
- Departments of Pathology and Dentistry, Mount Sinai Hospital, Toronto, ON Canada
| | | | - Jennifer L. Hunt
- Department of Pathology, Massachusetts General Hospital, Boston, MA USA
| | - Bayardo Perez-Ordoñez
- Department of Pathology, University Health Network, Toronto, ON Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, ON Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
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