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Simões AM, Sequeira-Mendes J, Santos AI. Beyond the Bones: A Case Report of Extraosseous Ewing Sarcoma. Cureus 2023; 15:e47961. [PMID: 38034204 PMCID: PMC10685669 DOI: 10.7759/cureus.47961] [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] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Ewing sarcoma (ES) is primarily recognized as a primary bone tumor; however, its extraosseous variant is exceptionally rare and presents unique clinical challenges. In this article, we report the case of a 22-year-old male who initially presented with abdominal swelling. Diagnostic tests included abdominal imaging and a CT scan, revealing a solid liver mass. A thorough evaluation confirmed it to be an extraosseous ES, supported by liver biopsy and immunohistochemistry demonstrating positive expression for AE1/AE3 and CD-99, along with genetic analysis revealing a rearrangement of the EWSR1 gene (translocation 22q12). The patient's treatment involved a multimodal approach, including perioperative chemotherapy, surgery, and postoperative chemotherapy, following which the patient remained in complete remission after 24 months. This case emphasizes the importance of considering rare malignancies such as ES in differential diagnoses for young patients with liver masses. It also accentuates the pivotal role of family physicians in early detection and holistic patient care, underscoring the need for comprehensive investigations when encountering persistent symptoms.
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Affiliation(s)
- Ana Margarida Simões
- Family Medicine, Unidade de Saúde Familiar A Ribeirinha, Unidade Local de Saúde Guarda, Guarda, PRT
| | - Joana Sequeira-Mendes
- Family Medicine, Unidade de Saúde Familiar A Ribeirinha, Unidade Local de Saúde Guarda, Guarda, PRT
| | - Ana Isabel Santos
- Family Medicine, Unidade de Saúde Familiar A Ribeirinha, Unidade Local de Saúde Guarda, Guarda, PRT
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2
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Rashed AA, Alharthi R, Aljabri S, Alsubhi R, Bukhari DH. Peripheral Primitive Neuroectodermal Tumor: A Rare Case in Pediatrics. Cureus 2023; 15:e39005. [PMID: 37323326 PMCID: PMC10263374 DOI: 10.7759/cureus.39005] [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] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Primitive neuroectodermal tumors (PNETs) are a type of malignant tumors made up of small neuroectodermal-derived round cells that affect soft tissue and bone, with a wide range of clinical symptoms and histological commonalities depending on the site of the tumor. PNETs account for 4% of all pediatric and adolescent cancers. Here we report a case of a peripheral primitive neuroectodermal tumor in a five-year-old boy. Two days before admission, he complained of multiple attacks of vomiting and one episode of hematemesis, associated with subjective fever, abdominal pain, and distention. He also complained of weight loss and bruises on his face and lower extremities for the last four weeks. Upon physical examination, there was hepatomegaly to the right iliac fossa. Abdominal ultrasound showed that the liver is hugely enlarged with heterogeneous echo texture and smooth borders. A computed tomography scan with contrast showed hepatomegaly to the right iliac fossa region with no focal lesion. Bone marrow aspiration and bone marrow biopsy showed heavy infiltration by monomorphic cells. Moreover, liver biopsy was done for this patient, and it showed metastatic undifferentiated neuroblastoma. Before the liver biopsy results, the patient deteriorated rapidly and dead. Therefore, peripheral primitive neuroectodermal tumors (pPNETs) should be considered in the differential diagnosis of liver masses in young patients to early diagnosis and treatment, and to increase the survival rate.
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Affiliation(s)
- Atef A Rashed
- Pediatrics, Maternity and Children's Hospital, Makkah, SAU
| | - Reem Alharthi
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | - Shuaa Aljabri
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | - Raghad Alsubhi
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | - Deemah H Bukhari
- Otolaryngology - Head and Neck Surgery, Maternity and Children's Hospital, Makkah, SAU
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3
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Hedfi M, Ben Ismail I, Zenaidi H, Bouslama S, Zoghlami A. Primary Ewing sarcoma of the liver: Diagnosis, management, and prognosis: A case report and literature review. Clin Case Rep 2022; 10:e6508. [PMID: 36381031 PMCID: PMC9647335 DOI: 10.1002/ccr3.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/04/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
Ewing's sarcoma tumors (ES) are a rare entity exceptionally localized on the liver. We report a case of an ES of the liver in a 26‐year‐old man who presented with abdominal pain. The diagnosis was confirmed with a histopathological examination of the left hepatectomy specimen and adjuvant chemotherapy was received.
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Affiliation(s)
- Mohamed Hedfi
- Department of General Surgery, Zaghouan Regional Hospital University of Tunis El Manar Tunis Tunisia
| | - Imen Ben Ismail
- Department of General Surgery, Trauma and Burns Center University of Tunis El Manar Tunis Tunisia
| | - Hakim Zenaidi
- Department of General Surgery, Zaghouan Regional Hospital University of Tunis El Manar Tunis Tunisia
| | - Sirine Bouslama
- Department of Pathology, Zaghouan Regional Hospital University of Tunis El Manar Tunis Tunisia
| | - Ayoub Zoghlami
- Department of General Surgery, Trauma and Burns Center University of Tunis El Manar Tunis Tunisia
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4
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Lu T, Yang W, Liu X, Yang X, Yang C, Di W. Imaging Findings of Hepatic Ewing's Sarcoma on Computed Tomography and Gadobenate Dimeglumine-enhanced Magnetic Resonance Imaging: A Case Report and Literature Review. J Clin Transl Hepatol 2022; 10:564-569. [PMID: 35836756 PMCID: PMC9240243 DOI: 10.14218/jcth.2021.00129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
Ewing's sarcoma (ES) is a tumor that often occurs in the long bones and rarely arises from visceral organs primarily. Here, we report a case of primary hepatic ES, discuss its computed tomography (CT) and gadobenate dimeglumine-enhanced magnetic resonance (MRI) features. This is the first Chinese and fifth primary hepatic ES case reported, based on a literature review. Imaging examinations showed that the tumor was solid, with necrosis and hemorrhage. Contrast-enhanced images showed that the tumor was hypervascular and especially had heterogeneous signal intensity on hepatobiliary phase MRI images. Intratumoral vessels and vascular invasion were also present.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wenhao Yang
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xingchao Liu
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xudan Yang
- Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chong Yang
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
- Correspondence to: Wenjia Di and Chong Yang, Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China. ORCID: https://orcid.org/0000-0002-0060-706X (CY). Tel: +86-28-8739-3707, Fax: +86-28-8778-5585, E-mail: (WD), (CY)
| | - Wenjia Di
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
- Correspondence to: Wenjia Di and Chong Yang, Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China. ORCID: https://orcid.org/0000-0002-0060-706X (CY). Tel: +86-28-8739-3707, Fax: +86-28-8778-5585, E-mail: (WD), (CY)
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5
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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.
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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
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Dai J, He HC, Huang X, Sun FK, Zhu Y, Xu DF. Long-term survival of a patient with a large adrenal primitive neuroectodermal tumor: A case report. World J Clin Cases 2019; 7:340-346. [PMID: 30746375 PMCID: PMC6369397 DOI: 10.12998/wjcc.v7.i3.340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/11/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adrenal primitive neuroectodermal tumor (PNET) is an extremely rare malignant tumor with poor prognosis and of neural crest origin. Herein, we report a case of adrenal PNET and summarized its clinical and pathological characteristics on the basis of 16 patients reported recently.
CASE SUMMARY A female patient aged 25 years presented with right lumbago for 12 mo, and pre-operative computed tomography showed a huge right adrenal mass. She received tumorectomy, and post-operative pathological examination showed adrenal PNET. After surgery, she underwent adjuvant chemotherapy and was followed up 31 mo after surgery. She received brachytherapy for right paracolic and hepatic metastases. She was alive and followed up for 60 mo. In available studies, only 57.14% (4/7) and 44.44% (4/9) were positive for the expression of neuron-specific enolase and synaptophysin, respectively, although CD99 expression was found in all the patients (100%; 10/10).
CONCLUSION It is concluded that adrenal PNET is very rare and highly malignant, and histology is a golden standard in its diagnosis. Surgery and adjuvant therapy is the main treatment.
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Affiliation(s)
- Jun Dai
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Hong-Chao He
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Xin Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Fu-Kang Sun
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Yu Zhu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Dan-Feng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
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7
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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
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8
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Sun Q, Miao B, Lao X, Yuan P, Cai J, Zhan H. Primitive neuroectodermal tumor of the kidney at the advanced stage: A case series of eight Chinese patients. Mol Clin Oncol 2018; 8:743-748. [PMID: 29805790 DOI: 10.3892/mco.2018.1611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
Primitive neuroectodermal tumor (PNET) rarely occurs as a primary renal neoplasm. Renal (r)PNET is a rare but aggressive neoplasm with poor prognosis; the majority of patients are diagnosed as advanced stage at presentation and face a worse prognosis than patients with localized disease. The present study describes the diagnosis and management of eight cases of rPNET at an advanced stage, who were treated at two institutions [Lingnan Hospital (branch of The Third Affiliated Hospital) and the Cancer Center of Sun Yat-sen University, Guangzhou], from December 2004 to January 2013. The clinical and pathological results of all patients were retrospectively obtained. Kaplan-Meier analysis was performed to estimate patient survival. The study cohort comprised five males and three females. Radical nephrectomy was performed in seven cases, while the remaining case only received needle biopsy of the tumor. Five cases received adjuvant chemotherapy, while three received no further treatment after surgery. Of note, one case received cytokine-induced killer (CIK) cell immunotherapy combined with surgery and chemotherapy. The overall median survival was 20 months with a 3-year survival rate of 25%. The overall survival of the four patients who received adjuvant chemotherapy following surgery was 36 months, compared with 10 months in the three patients without further treatment. The patient who received CIK cell immunotherapy survived for 20 months. Based on the observations of the present and previous studies, surgical excision and chemotherapy are recommended for treating rPNET at advanced stage. Furthermore, the present study was the first to report on CIK cell immunotherapy for a patient with rPNET, indicating that it may be a promising optional treatment. However, further studies are required to validate the benefit of CIK cells and to establish an appropriate immunotherapy protocol.
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Affiliation(s)
- Qipeng Sun
- Department of Urology, Lingnan Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510530, P.R. China
| | - Bin Miao
- Department of Renal Transplantation, Lingnan Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510530, P.R. China
| | - Xiangming Lao
- Department of Hepatobiliary Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Ping Yuan
- Department of Obstetrics and Gynecology, IVF Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jiarong Cai
- Department of Urology, Lingnan Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510530, P.R. China
| | - Hailun Zhan
- Department of Urology, Lingnan Hospital, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510530, P.R. China
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9
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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]
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10
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Tonyalı Ş, Yazıcı S, Yeşilırmak A, Ergen A. The Ewing's Sarcoma Family of Tumors of Urinary Bladder: A Case Report and Review of the Literature. Balkan Med J 2016; 33:462-6. [PMID: 27606145 PMCID: PMC5001827 DOI: 10.5152/balkanmedj.2016.16533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Only 15 cases of Ewing's Sarcoma (EWS) family of tumors of urinary bladder have been documented in the literature to date. CASE REPORT We presented here a 38 year-old female with primary urinary bladder EWS with no distant metastases. She had presented with macroscopic hematuria and had undergone transurethral resection of the tumor within the following week. Microscopic examination revealed a tumor diffusely infiltrating the lamina propria and muscularis propria under an intact urothelium, which was composed of small round blue cells with scant cytoplasm, monotonous round or oval nuclei, stippled chromatin and small nucleoli. Immunohistochemistry showed strong vimentin, synaptophysin and membranous CD99 expression by the tumor. Fluorescent in situ hybridization analysis displayed the EWSR1 rearrangement. Radical cystectomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy, extended lymph node dissection, and ileal conduit were performed. As adjuvant chemotherapy, she received vincristine, doxorubicin, cyclophosphamide and mesna, alternating with courses of etoposide, iphosphamide and mesna. She is alive and well with no evidence of disease 14 months after the surgery. CONCLUSION Surgery supported with chemotherapy should be considered as an option, especially in advanced Ewing's sarcoma family of tumors of urinary bladder.
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Affiliation(s)
- Şenol Tonyalı
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sertaç Yazıcı
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysun Yeşilırmak
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Ergen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Pochon C, Martelli H, Mussini C, Pariente D, Heymann MF, Corradini N. Primary Hepatic Ewing Sarcoma With EWS-FLI1 RNA Transcript in a Child. J Pediatr Hematol Oncol 2015; 37:411-3. [PMID: 25411865 DOI: 10.1097/mph.0000000000000289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cécile Pochon
- *Pediatric and Adolescent Oncology Department, Nantes University Hospital ∥Physiopathology of Bone Resorption and Therapy of Primitive Bone Tumors Laboratory, Nantes University UMR 957 ¶Pathology Department, Centre Hospitalier Universitaire, Nantes Departments of †Pediatric Surgery ‡Pediatric Pathology §Pediatric Radiology, Bicêtre Hospital Le Kremlin-Bicêtre, France
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12
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Ozturk H. Peripheral neuroectodermal tumour of the kidney (Ewing's sarcoma): Restaging with (18)F-fluorodeoxyglucose (FDG)-PET/CT. Can Urol Assoc J 2015; 9:E39-44. [PMID: 25624967 DOI: 10.5489/cuaj.2286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primitive peripheral neuroectodermal tumour and Ewing's sarcoma (PNET/EWS) were originally described as two distinct pathologic entities, although both share common stem-cell precursor and unique chromosomal abnormality. Although its incidence has increased recently, its share in all sarcomas is 1%. It is usually seen in men and women in their twenties. We present a case of a 38-year-old woman with a left renal mass detected incidentally. Magnetic resonance imaging revealed a centrally located hypervascular renal mass with diameter of 6 cm with non-homogenous contrast enhancement containing necrotic and calcific areas. The patient was diagnosed as having PNET/EWS by histopathological examination following radical nephrectomy. Para-aortic lymph node metastasis was found on imaging by (18)F-fluorodeoxyglucose (FDG)-positron-emission tomography/computed tomography (PET/CT).
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Affiliation(s)
- Hakan Ozturk
- Department of Urology, School of Medicine, Sifa University, Izmir-Turkey
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13
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Ozaki Y, Miura Y, Koganemaru S, Suyama K, Inoshita N, Fujii T, Hashimoto M, Tamura T, Takeuchi K, Takano T. Ewing sarcoma of the liver with multilocular cystic mass formation: a case report. BMC Cancer 2015; 15:16. [PMID: 25608963 PMCID: PMC4307901 DOI: 10.1186/s12885-015-1017-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/09/2015] [Indexed: 12/17/2022] Open
Abstract
Background Ewing sarcoma is a rare tumor that occurs commonly in the long bones of children or adolescents that can also arise in soft tissues including the extremities, retroperitoneum, chest wall, and rarely in the liver as primary sites. We report a case of Ewing sarcoma arising primarily in the liver and, to our knowledge, this is the fourth reported case of Ewing sarcoma occurring in the liver. Case presentation A 27-year-old Japanese woman was admitted with sudden onset right upper abdominal pain. Clinical examination revealed a multilocular cystic mass consisting of thickened, irregular septa and nodal walls in the right hepatic lobe. Ultrasound-guided aspiration biopsy of the liver mass showed clusters of small atypical round cells and the clinical preoperative diagnosis was mucinous cystadenoma of the liver. The patient underwent an extended right hepatectomy and histopathological findings revealed sheet-like proliferation of small- to medium-sized round cells. Tumor cells were positive for periodic acid-Schiff reaction and immunoreactive for glycoprotein C99 and gene NKX2.2, as well as the neuroendocrine markers, CD56 and synaptophysin. EWS-FLI-1 fusion transcript type 1 was detected by reverse transcriptase polymerase chain reaction. Pathological and molecular analysis confirmed the diagnosis of Ewing sarcoma arising primarily in the liver and the patient received adjuvant systemic chemotherapy with vincristine, doxorubicin, and cyclophosphamide, alternating with ifosfamide and etoposide. We found no evidence of recurrence 15 months after completing chemotherapy. Conclusion We present an extremely rare case of Ewing sarcoma arising primarily in the liver. To our knowledge, this is the fourth reported case of Ewing sarcoma occurring in the liver, and the first case with a multilocular cystic liver mass. Imaging examinations of the other three reported cases showed solid tumors and a diffuse enlarged liver without mass lesion. Clinicians should consider the possibility of Ewing sarcoma in young patients with a multilocular cystic mass with thick and/or irregular cyst walls in the liver.
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Affiliation(s)
- Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Shigehiro Koganemaru
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Koichi Suyama
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Naoko Inoshita
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.
| | - Masaji Hashimoto
- Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan.
| | - Tetsuo Tamura
- Department of Gastrointestinal Medicine, Toranomon Hospital, Tokyo, Japan.
| | - Kazuo Takeuchi
- Department of Gastrointestinal Medicine, Toranomon Hospital, Tokyo, Japan.
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
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14
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Zhong J, Chen N, Chen X, Gong J, Nie L, Xu M, Zhou Q. Peripheral primitive neuroectodermal tumor of the kidney in a 51-year-old female following breast cancer: A case report and review of the literature. Oncol Lett 2014; 9:108-112. [PMID: 25435942 PMCID: PMC4246623 DOI: 10.3892/ol.2014.2695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
Peripheral primitive neuroectodermal tumor/Ewing's sarcoma (pPNET/EWS) is an aggressive type of sarcoma that is rarely observed in the kidney. pPNET of the kidney principally occurs in young patients (<50 years old) and is very rare in older patients (≥50 years old). Additionally, only six cases of pPNET of the kidney have been reported in the literature in older patients (≥50 years old), and pPNET as a secondary primary tumor has rarely been reported. The current study presents a case of renal pPNET in a 51-year-old female who had been surgically treated for breast carcinoma and administered with adjuvant chemotherapy five years prior to hospitalization for pPNET. A computed tomography scan identified a tumor in the lower pole of the right kidney, which was treated by nephrectomy. Immunohistochemistry demonstrated diffuse, strong membranous positivity for cluster of differentiation (CD)99, positive nuclear staining for friend leukemia integration 1, and negative staining for Wilms' tumor 1 and other markers. Fluorescence in situ hybridization (FISH) analysis of the EWS breakpoint region 1 (EWSR1) demonstrated the characteristic EWSR1 translocation. The patient declined chemotherapy or radiotherapy but accepted traditional Chinese medicine. No evidence of recurrence was observed eight months after diagnosis. Only two cases of renal pPNET with a history of an earlier or synchronous primary cancer were reported in the literature from the USA and Germany, respectively. To the best of our knowledge, the present case is the first FISH-confirmed renal pPNET in an older patient following breast adenocarcinoma.
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Affiliation(s)
- Jinjing Zhong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xueqin Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jing Gong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ling Nie
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Miao Xu
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
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McGrann PF, Pooleman IJ, Wilson CH, Haugk B, Scott J, Charnley RM. Primary hepatic Ewing's sarcoma with cytogenetic confirmation. J Gastrointest Surg 2014; 18:635-7. [PMID: 23877327 DOI: 10.1007/s11605-013-2284-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/02/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Extraskeletal Ewing's sarcoma is reported in the medical literature, but none has been described as presenting with a resectable liver mass. METHODS A case of a 29-year-old male patient who presented with a large symptomatic mass in the right lobe of the liver which, following resection, demonstrated the characteristic histopathology and fusion protein (EWSR1-Fli1) found in Ewing's sarcoma was reported. DISCUSSION Complete surgical resection offers the best long-term outlook. Cure rates with appropriate surgical and chemotherapeutic management range between 30 and 60 %.
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Affiliation(s)
- P F McGrann
- Department of Hepatopancreaticobiliary Surgery, The Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, UK, NE7 7DN
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Fernandez-Flores A, Suarez-Peñaranda JM, Alonso S. Study of EWS/FLI-1 Rearrangement in 18 Cases of CK20+/CM2B4+ Merkel Cell Carcinoma Using FISH and Correlation to the Differential Diagnosis of Ewing Sarcoma/Peripheral Neuroectodermal Tumor. Appl Immunohistochem Mol Morphol 2013; 21:379-85. [DOI: 10.1097/pai.0b013e318273a9e0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rare hepatic malignant tumors: dynamic CT, MRI, and clinicopathologic features: with analysis of 54 cases and review of the literature. ACTA ACUST UNITED AC 2012; 38:511-26. [DOI: 10.1007/s00261-012-9918-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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18
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Primitive neuroectodermal tumor of the liver: a case report. Case Rep Med 2011; 2011:748194. [PMID: 22242031 PMCID: PMC3254232 DOI: 10.1155/2011/748194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 09/26/2011] [Accepted: 09/29/2011] [Indexed: 12/28/2022] Open
Abstract
Primary liver sarcomas represent a rare group of neoplasias, with angiosarcoma being the most common histological type. Primitive neuroectodermal tumor (PNET) represents a high malignant neoplasia that usually affects the central nervous system and soft tissues. An 18-year-old male patient was admitted with clinical complains of pain in the right upper abdominal quadrant. The clinical evaluation revealed a solid mass in the right hepatic lobe. On the gross examination of the resected liver specimen, the right lobe of the liver was replaced by a yellow-red solid mass measuring 21 cm in its largest dimension. On the histopathology, a tumor composed of small round blue cells with little cytoplasm and round nuclei was identified. The lesion revealed positive immunoexpression for vimentin and CD99 and negative immunostaining for desmin, CD45, cytokeratin, and neuroblastoma protein, suggesting, then, the diagnosis of PNET. Although it is an unusual tumor, it should be considered in the differential diagnosis of liver masses, especially in young patients.
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Marques M, Cardoso H, Barroca H, Lopes J, Macedo G. Peripheral primitive neuroectodermal tumour of the liver: a case report and review of the literature. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:611-3. [PMID: 22035645 DOI: 10.1016/j.gastrohep.2011.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/28/2011] [Accepted: 06/01/2011] [Indexed: 01/23/2023]
Abstract
Peripheral primitive neuroectodermal tumour (PNET) is a malignant mesenchymal tumour. Although PNETs can occur in numerous solid organs, it is an extremely rare tumour entity, specially involving the liver. We report a 19-year-old boy with Hepatitis B Virus (HBV) infection who was diagnosed with a primary PNET of the liver.
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Primary Ewing's Sarcoma of the Kidney in a 73-Year-Old Man. Sarcoma 2011; 2011:978319. [PMID: 21776194 PMCID: PMC3137979 DOI: 10.1155/2011/978319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 01/03/2023] Open
Abstract
Objective. Ewing's sarcoma of the kidney is rare and is usually found in young adults. We present here a single case study of Ewing's sarcoma found in an elderly man. Material and methods. A 73-year-old man underwent routine surgery for hydrocoele of the testis. He developed urinary obstruction symptoms, and radiological examinations revealed a tumour in the right kidney. Results. Microscopical, immunohistochemical, and molecular pathological analysis of the tumour was consistent with Ewing's sarcoma. FISH showed rearrangement of chromosomes 22q12 (EWSR1). The patient subsequently underwent nephrectomy followed by 6 adjuvant chemotherapy cycles. Follow-up after 7 months shows no recurrence. Conclusion. This case report presents not only the rare finding of Ewing's sarcoma in the kidney, but also the occurrence of this tumour entity in an elderly patient. Treatment options for the different types of renal tumours are vastly different and the need for a correct diagnosis is, therefore, vital.
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Affiliation(s)
- Geunyoung Jung
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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