1
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Xiao Y, Zhi Y, Cao G, Ma H, Gao J, Li F. Primary Ewing's sarcoma of the uterine cervix: a case report and review of the literature. J Cancer Res Clin Oncol 2024; 150:267. [PMID: 38769118 PMCID: PMC11106175 DOI: 10.1007/s00432-024-05698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Ewing's sarcoma (ES) is an aggressive cancer of bone and soft tissue, most of which tend to occur in the bone. Extraosseous Ewing's sarcoma (EES) of the cervix is extremely rare. CASE PRESENTATION In the present work, we reported a 39-year-old cervical EES patient with a 2.5*2.1*1.8 cm tumor mass. According to previous literatures, our case is the smallest tumor found in primary cervical ES ever. The patient initially came to our hospital due to vaginal bleeding, and then the gynecological examination found a neoplasm between the cervical canal and partially in the external cervical orifice. The diagnosis of EES was confirmed below: Hematoxylin & Eosin staining (H&E) revealed small round blue malignant cells in biopsy specimens. Immunohistochemistry (IHC) showed the positive staining for CD99, NKX2.2, and FLI1. Disruption of EWSR1 gene was found by fluorescence in situ hybridization (FISH), and the EWSR1-FLI1 gene fusion was determined by next-generation sequencing (NGS). The patient received laparoscopic wide hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, and postoperative adjuvant chemotherapy and remained disease free with regular follow-up for 1 year. CONCLUSIONS Through a systematic review of previously reported cervical ES and this case, we highlighted the importance of FISH and NGS for the accuracy of ESS diagnosis, which could assist on the optimal treatment strategy. However, due to the rarity of the disease, there is no standard treatment schemes. Investigation on molecular pathological diagnosis and standardization of treatment regimens for cervical ES are critical to patients' prognosis.
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Affiliation(s)
- Yuhang Xiao
- Department of Gynecology, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yong Zhi
- Department of Gynecology, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Guangxu Cao
- Department of Gynecology, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Heling Ma
- Department of Gynecology, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jinli Gao
- Department of Pathology, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.
| | - Fang Li
- Department of Gynecology, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.
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2
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Wei D, Jianguo Z, Xiao L, Pengpeng Q. Primary primitive neuroectodermal tumor of the cervix confirmed with molecular analysis in a pregnant woman: A case report and literature review. Front Genet 2022; 13:871531. [PMID: 36035131 PMCID: PMC9399424 DOI: 10.3389/fgene.2022.871531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Primary primitive neuroectodermal tumor (PNET) in the female tract is rare. Recently, a case of cervical PNET was diagnosed in our hospital. A 29-year-old pregnant woman presented with a cystic-solid cervical mass at the 7th week of gestation. The mass grew rapidly during follow-up and ruptured at the 22nd week. A biopsy was performed on the mass. Pathological examination revealed a malignant neoplasm composed of small cells which exhibited positive immunohistochemical (IHC) staining for CD99, SYN, and FLI1. Fluorescence in situ hybridization (FISH) displayed the presence of EWS-FLI1 fusion gene resulting from the chromosomal translocation t (11;22, q24;q12), which confirmed the diagnosis of cervical PNET. The reverse transcription-polymerase chain reaction (RT-PCR) results showed type 2 EWS-FLI1 fusion occurred in this tumor, suggesting a poor prognosis. The patient underwent surgical resection and was given adjuvant chemotherapy followed by pelvic radiotherapy. PNET arising from the genital tract, especially in the uterine cervix, is very rare and presents a diagnostic challenge. FISH and RT-PCR analysis are helpful for the diagnosis of such a tumor at an unusual site, as in the present case.
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Affiliation(s)
- Ding Wei
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Zhao Jianguo
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Li Xiao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Qu Pengpeng
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China
- *Correspondence: Qu Pengpeng,
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3
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Cheng Y, Bai Q, Wu B, Chang B, Bi R, Yang W, Wang J, Tu X. Clinicopathologic and Molecular Cytogenetic Analysis of 8 Cases With Uterine Cervical Ewing Sarcoma: Case Series With Literature Review. Am J Surg Pathol 2021; 45:523-530. [PMID: 33538423 DOI: 10.1097/pas.0000000000001674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ewing sarcoma (ES) is a highly malignant tumor that rarely occurs in the uterine cervix. Herein, we report 8 cases with ES arising primarily in the uterine cervix by focusing on clinicopathologic and molecular cytogenetic features and differential diagnoses. Eight cases of cervical ES were diagnosed between February, 2012, and September, 2018. The age of patients ranged from 13 to 47 years. Abnormal vaginal bleeding and lower abdominal pain were the most common symptoms. Histologically, the tumor was composed of uniform, round, and oval cells with a narrow rim of eosinophilic cytoplasm. Fibrous septa were observed between tumor cell nests. The tumors showed brisk mitotic activity and areas of coagulative necrosis. According to immunohistochemical studies, 50% (4/8) of the cases were positive for cytokeratin (AE1/AE3), and 87.5% (7/8) were positive for synaptophysin, which resulted in a diagnostic confusion with small cell carcinoma, primarily when dealing with small cervical biopsies. Molecular testing demonstrated the rearrangement of the EWSR1 gene in all of the 8 cases, which confirmed the diagnosis of ES. Although rare, ES should be considered as indicators of cervical small round cell neoplasms. Molecular analysis may greatly contribute to the final diagnosis of ES occurring in this unusual location.
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Affiliation(s)
- Yufan Cheng
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qianming Bai
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Wu
- Radiology, Fudan University Shanghai Cancer Center.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Chang
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Bi
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wentao Yang
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Wang
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoyu Tu
- Departments of Pathology.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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4
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Gupta V, Raju KVVN, Sridhar D, Ahmed SM, Fonseca D. Primary Ewing's Sarcoma/Primitive Neuroectodermal Tumour of the Cervix: a Rare Tumour. Indian J Surg Oncol 2020; 11:162-165. [PMID: 32205989 DOI: 10.1007/s13193-019-00965-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vikas Gupta
- 1Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - K V V N Raju
- 1Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - D Sridhar
- 1Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Syed Murtaza Ahmed
- 1Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Daphne Fonseca
- 2Department of Laboratory Medicine, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
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5
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Zhang Y, Nong W, Ren Y, Jiang J, Zhang H, Meng L, Li Q, Zhang Q, Wang X, Wang Y, Liu C, Li F. Ewing's sarcoma of the cervix: A case report and review of literature. Histol Histopathol 2019; 35:475-480. [PMID: 31688946 DOI: 10.14670/hh-18-181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ewing's sarcoma (ES) is a small cell malignant tumor that occurs in the bone of children or adolescents. ES can also occur in extraskeletal organs, such as the pancreas, thyroid, liver, proximal phalanx, and, rarely, cervix. Only 15 published case reports have discussed ES arising in the cervix. We report a 76-year-old woman who had groin mass. ES was diagnosed in accordance with morphological and immunohistochemical maps. Fluorescence in situ hybridization and RT-PCR (reverse transcription PCR) revealed ESWR1 gene rearrangement and fusion gene formation (EWS-FLI-1), both of which confirmed the diagnosis of ES. Although the patient underwent surgical resection, the patient died without chemotherapy and radiotherapy. This case is the first one to involve a patient aged over 70 years and the fifth one to show metastasis occurrence.
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Affiliation(s)
- Yangyang Zhang
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Weixia Nong
- Department of Hematology, The First Affiliated Hospital of Medical College of Shihezi University, Shihezi, Xinjiang, China
| | - Yan Ren
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Jinfang Jiang
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Haijun Zhang
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Lian Meng
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Qianru Li
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Qiaochu Zhang
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Xiaomeng Wang
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Yang Wang
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China
| | - Chunxia Liu
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China.
| | - Feng Li
- Department of Pathology, Shihezi University School of Medicine and The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Chinese Ministry of Education, Shihezi, Xinjiang, China.,Department of Pathology, Beijing Chaoyang Hospital and Medical Reaearch Center, Capital Medical University, Beijing, China.
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6
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Kyriazoglou A, Tsironis G, Liontos M, Papakosta A, Mahaira L, Thomakos N, Morphopoulos G, Papaspyrou I, Bamias A. Ewing's sarcoma of the cervix: A case report of an unusual diagnosis in pregnancy treated with surgery, adjuvant VIDE and radiotherapy. Oncol Lett 2019; 17:5529-5535. [PMID: 31186774 PMCID: PMC6507342 DOI: 10.3892/ol.2019.10267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/27/2018] [Indexed: 12/11/2022] Open
Abstract
Ewing's sarcoma of the cervix is a rare entity and presents with considerable challenges in diagnosis and therapy. Herein, we report a case of a cervical Ewing's sarcoma presenting with FIGO stage Ib, diagnosed during the first trimester of the patient's pregnancy. Imaging with CT scans, MRI of her abdomen and PET-CT verified the locoregional extension of the tumor. The diagnosis was confirmed by immunohistochemistry and molecular analysis. Fluorescence in situ hybridization and RT-PCR detected the pathognomonic EWS/FLI fusion gene. Favorable prognostic factors regarding the stage, clinocopathological and molecular characteristics of the tumor are also described. Due to the rarity of the disease, at present, there is no universal consensus on the optimal therapeutic approach. The literature has been reviewed and the therapeutic schemes and available clinical data have been discussed. The patient presented in this case report was treated aggressively with tri-modality therapy and underwent radical hysterectomy followed by adjuvant chemotherapy with Vincristine-Ifosfamide-Doxorubicin-Etoposide and radiotherapy. The patient remains free of this disease 42 months following the diagnosis of her tumor.
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Affiliation(s)
| | - Georgios Tsironis
- Department of Clinical Therapeutics, Alexandra Hospital, 11528 Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, Alexandra Hospital, 11528 Athens, Greece
| | - Alexandra Papakosta
- Department of Genetics, Agios Savvas Hospital, Alexandra Hospital, 11528 Athens, Greece
| | - Luisa Mahaira
- Department of Genetics, Agios Savvas Hospital, Alexandra Hospital, 11528 Athens, Greece
| | - Nikolaos Thomakos
- Department of Obstetrics and Gynecology, Alexandra Hospital, 11528 Athens, Greece
| | | | - Irene Papaspyrou
- Department of Pathology, Alexandra Hospital, 11528 Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra Hospital, 11528 Athens, Greece
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7
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De Nola R, Di Naro E, Schonauer LM, Lucarelli G, Battaglia M, Fiore MG, Mastrolia SA, Loverro G. Clinical management of a unique case of PNET of the uterus during pregnancy, and review of the literature. Medicine (Baltimore) 2018; 97:e9505. [PMID: 29480840 PMCID: PMC5943895 DOI: 10.1097/md.0000000000009505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE PNETs (primitive neuroectodermal tumors) are a family of highly malignant neoplasms characterized by small round cells of neuroepithelial origin. They usually involve bone and soft tissues, and have a higher incidence in childhood. PATIENT CONCERNS In this case report, we describe the obstetric and oncological outcome of a huge mass diagnosed as a leiomyoma in a 39-year-old pregnant woman who complained of low back pain, dysuria, and urinary frequency at 22 weeks of gestation. DIAGNOSES During the 25th week of pregnancy, the patient was referred to our hospital at night with severe anemia and suspected hemoperitoneum. She underwent an emergency caesarean section, delivering a female fetus weighing 400 g, with an Apgar score of 7 at 1 minute and 9 at 5 minutes. INTERVENTION During surgery, we found a huge uterine sarcoma-like metastatic tumor, invading the pelvic peritoneum and parametria bilaterally; the adnexae seemed disease-free. We performed a type B radical hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, omentectomy, appendectomy, and excision of a bulky lymph node. Seven days after delivery, staging computed tomography (CT) scan demonstrated a large lombo-aortic lymph node compressing the left renal vein and we completed debulking with a second surgery, including diaphragmatic peritonectomy and excision of a huge lymph node by lombo-aortic lymphadenectomy, requiring partial reconstruction of an infiltrated renal vein. OUTCOME Ten days after the second surgery, echo-color Doppler showed a regular microcirculation in the left kidney. The patient was discharged after 10 days, and the baby after 1 month, both in good health.Histological examination revealed a uterine body cPNET (central primitive neuroectodermal tumor) orienting the clinical management toward chemotherapy with cisplatin and etoposide. LESSONS PNETs are aggressive neoplasms, usually diagnosed at an advanced stage. Due to their low incidence, universally accepted guidelines are still unavailable. Radical surgery leaving no macroscopic residual disease is mandatory in advanced stages. A good fertility-sparing procedure can be performed only in young women at early stages of disease, when the wish for childbearing is not yet fulfilled.
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Affiliation(s)
- Rosalba De Nola
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Luca Maria Schonauer
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit
| | | | | | - Giuseppe Loverro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic
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8
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Primitive Neuroectodermal Tumors of the Female Genital Tract: A Morphologic, Immunohistochemical, and Molecular Study of 19 Cases. Am J Surg Pathol 2017; 41:761-772. [PMID: 28296680 DOI: 10.1097/pas.0000000000000831] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary primitive neuroectodermal tumor (PNET) of the female genital tract is rare, and its proper classification remains unclear. The clinical, histologic, and immunophenotypic features as well as EWSR1 rearrangement status of 19 gynecologic PNETs, including 10 ovarian, 8 uterine, and 1 vulvar tumors, are herein reported. Patient age ranged from 12 to 68 years, with a median age of 20 and 51 years among those with ovarian and uterine PNETs, respectively. Morphologic features of central nervous system (CNS) tumors were seen in 15 PNETs, including 9 medulloblastomas, 3 ependymomas, 2 medulloepitheliomas, and 1 glioblastoma, consistent with central PNET. The remaining 4 PNETs were composed entirely of undifferentiated small round blue cells and were classified as Ewing sarcoma/peripheral PNET. Eight PNETs were associated with another tumor type, including 5 ovarian mature cystic teratomas, 2 endometrial low-grade endometrioid carcinomas, and a uterine carcinosarcoma. By immunohistochemistry, 17 PNETs expressed at least 1 marker of neuronal differentiation, including synaptophysin, NSE, CD56, S100, and chromogranin in 10, 8, 14, 8, and 1 tumors, respectively. GFAP was positive in 4 PNETs, all of which were of central type. Membranous CD99 and nuclear Fli-1 staining was seen in 10 and 16 tumors, respectively, and concurrent expression of both markers was seen in both central and Ewing sarcoma/peripheral PNETs. All tumors expressed vimentin, whereas keratin cocktail (CAM5.2, AE1/AE3) staining was only focally present in 4 PNETs. Fluorescence in situ hybridization was successful in all cases and confirmed EWSR1 rearrangement in 2 of 4 tumors demonstrating morphologic features of Ewing sarcoma/peripheral PNET and concurrent CD99 and Fli-1 expression. In conclusion, central and Ewing sarcoma/peripheral PNETs may be encountered in the female genital tract with central PNETs being more common. Central PNETs show a spectrum of morphologic features that overlaps with CNS tumors but lack EWSR1 rearrangements. GFAP expression supports a morphologic impression of central PNET and is absent in Ewing sarcoma/peripheral PNET. Ewing sarcoma/peripheral PNETs lack morphologic features of CNS tumors.
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9
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Wang X, Gao Y, Xu Y, Liu Y, Qu P. Primary primitive neuroectodermal tumor of the cervix: A report of two cases and review of the literature. Mol Clin Oncol 2017; 6:697-700. [PMID: 28515922 DOI: 10.3892/mco.2017.1193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/23/2016] [Indexed: 12/31/2022] Open
Abstract
Peripheral primitive neuroectodermal tumor (PNET) of the cervix uteri is extremely rare. Two cases of PNET of the cervix are presented herein. Two female patients, aged 48 and 43 years, presented with irregular uterine bleeding over the course of 1 year, and increased urinary frequency for 1 month, respectively. On gynecological examination, a mass in the cervix was palpated and a biopsy performed. The findings of the initial biopsy revealed small-cell carcinoma in both patients. Following neoadjuvant chemotherapy and radiotherapy, radical hysterectomy was performed in both patients. One patient received 5 courses of consolidation chemotherapy and postoperative radiotherapy, whereas the other patient received 1 course of consolidation chemotherapy. At the time of the article submission, both patients remained disease-free at 27 and 12 months, respectively, after their initial diagnosis. Only a limited number of cases of PNET of the cervix uteri have been reported in the literature to date. Multimodal therapies, including total excision, adjuvant chemotherapy and/or radiotherapy, have been adopted to treat patients with PNET of the cervix.
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Affiliation(s)
- Xiaofeng Wang
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin 300100, P.R. China
| | - Yan Gao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin 300100, P.R. China
| | - Yanning Xu
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin 300100, P.R. China
| | - Yixin Liu
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin 300100, P.R. China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin 300100, P.R. China
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10
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Ahmad I, Chufal KS, Bhargava A, Bashir I. Primitive neuroectodermal tumour of the cervix: a rare diagnosis. BMJ Case Rep 2017; 2017:bcr-2016-217461. [PMID: 28052947 DOI: 10.1136/bcr-2016-217461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 48-year-old woman presented with symptoms of lower abdominal pain and vaginal discharge for 6 months. Clinical examination and pelvic ultrasound scan suggested a diagnosis of infected Gartner's cyst, for which she underwent vaginal cystectomy. However, histopathology and immunohistochemistry revealed a diagnosis of primitive neuroectodermal tumour of the cervix. Further investigations revealed the stage to be FIGO IIIB, which was inoperable. She received neoadjuvant chemotherapy (vincristine, adriamycin, cyclophosphamide alternating with ifosfamide, cisplatin and etoposide, every 21 days), but the tumour did not respond to treatment and she was started on radiotherapy with definitive intent (55.8 Gray in 31 fractions over 6.2 weeks). A PET-CT performed 2 months after completion of radiotherapy showed complete response, and she is now receiving adjuvant chemotherapy.
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Affiliation(s)
- Irfan Ahmad
- Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
| | - Kundan Singh Chufal
- Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
| | - Amit Bhargava
- Department of Medical Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
| | - Irfan Bashir
- Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
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11
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Mashriqi N, Gujjarlapudi JK, Sidhu J, Zur M, Yalamanchili M. Ewing's sarcoma of the cervix, a diagnostic dilemma: a case report and review of the literature. J Med Case Rep 2015; 9:255. [PMID: 26549660 PMCID: PMC4638088 DOI: 10.1186/s13256-015-0733-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Ewing's sarcoma belongs to a spectrum of neoplastic diseases known as Ewing's family of tumors. This family of tumors is usually seen in osseous sites. Ewing's sarcoma of the cervix is extremely rare, with only 18 cases reported in the English literature. The immunohistochemical profile of Ewing's sarcoma overlaps with other malignancies like small cell carcinoma. The rarity and complex pathologic picture of Ewing's sarcoma of the cervix creates the potential for misdiagnosis. Hence, we believe this case needs to be reported to add to the available literature. CASE PRESENTATION A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles. CONCLUSION With early diagnosis and appropriate treatment, Ewing's sarcoma of the cervix can be a potentially curable disease. However, owing to overlapping clinical and histopathological features, the diagnosis poses a challenge to oncologists and pathologists. This article guides pathologists to consider Ewing's sarcoma in the differential diagnosis of small cell carcinoma with weak staining for neuroendocrine markers. This literature review will benefit oncologists encountering this rare entity.
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Affiliation(s)
- Nazia Mashriqi
- United Health Services Wilson Medical Center, Johnson, NY, 13790, USA. .,Broome Oncology, United Health Services Wilson Medical Center, Johnson, NY, 13790, USA.
| | - Jaya Kranthi Gujjarlapudi
- United Health Services Wilson Medical Center, Johnson, NY, 13790, USA. .,Broome Oncology, United Health Services Wilson Medical Center, Johnson, NY, 13790, USA.
| | - Jagmohan Sidhu
- United Health Services Wilson Medical Center, Johnson, NY, 13790, USA. .,Broome Oncology, United Health Services Wilson Medical Center, Johnson, NY, 13790, USA.
| | - Michael Zur
- Our Lady of Lourdes Hospital, Binghamton, NY, 13905, USA.
| | - Madhuri Yalamanchili
- United Health Services Wilson Medical Center, Johnson, NY, 13790, USA. .,Broome Oncology, United Health Services Wilson Medical Center, Johnson, NY, 13790, USA.
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12
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Khosla D, Rai B, Patel FD, Sreedharanunni S, Dey P, Sharma SC. Primitive neuroectodermal tumor of the uterine cervix diagnosed during pregnancy: a rare case with review of literature. J Obstet Gynaecol Res 2015; 40:878-82. [PMID: 24738134 DOI: 10.1111/jog.12238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primitive neuroectodermal tumors of the cervix are very rare. A 28-year-old pregnant woman presented with a cervical mass. The tumor was staged as IB2. The biopsy from tumor was suggestive of malignant small round cell tumor. She then underwent termination of pregnancy followed by radical hysterectomy. Based on morphologic and immunohistochemical profile, a diagnosis of peripheral primitive neuroectodermal tumor of the cervix was made. The patient received adjuvant chemotherapy and radiotherapy. The patient is alive and disease-free 33 months post-surgery. The present case highlights the importance of keeping primitive neuroectodermal tumors in the differential diagnosis of small cell neoplasms of the uterine cervix. Pregnancy should not be a barrier to early detection and treatment of this potentially aggressive tumor. The optimal treatment methods have not yet been established because of the rarity of the tumor.
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MESH Headings
- Abortion, Therapeutic
- Adult
- Biopsy
- Cervix Uteri/pathology
- Chemoradiotherapy, Adjuvant
- Diagnosis, Differential
- Early Detection of Cancer
- Female
- Humans
- Hysterectomy
- Neoplasm Staging
- Neuroectodermal Tumors, Primitive, Peripheral/diagnosis
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Complications, Neoplastic/surgery
- Pregnancy Complications, Neoplastic/therapy
- Treatment Outcome
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/surgery
- Uterine Cervical Neoplasms/therapy
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13
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Li B, Ouyang L, Han X, Zhou Y, Tong X, Zhang S, Zhang Q. Primary primitive neuroectodermal tumor of the cervix. Onco Targets Ther 2013; 6:707-11. [PMID: 23836982 PMCID: PMC3699316 DOI: 10.2147/ott.s45889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary primitive neuroectodermal tumors (PNETs) are rare and high-grade malignant tumors that mostly occur in children and young adults. The most common sites are the trunk, limbs, and retroperitoneum. Herein, we present a case of a PNET involving the cervix uteri in a 27-year-old woman. The lesion showed characteristic histologic features of a PNET and was positive for the immunohistochemical markers cluster of differentiation (CD) 99, vimentin, neuron-specific enolase, neural cell adhesion molecule 1 (CD56), and CD117 (c-kit), further defining the tumor while helping to confirm PNET. The clinical Stage IIIB tumor was treated with chemotherapy and radiotherapy.
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Affiliation(s)
- Bo Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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14
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Arora N, Kalra A, Kausar H, Ghosh TK, Majumdar A. Primitive neuroectodermal tumour of uterine cervix - a diagnostic and therapeutic dilemma. J OBSTET GYNAECOL 2013; 32:711-3. [PMID: 22943734 DOI: 10.3109/01443615.2012.689028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Arora
- Department of Obstetrics and Gynaecology, ESI Post Graduate Institute of Medical Science and Research, Joka, India.
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15
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Dasari P, Verma SK. Extraosseous Ewing's Sarcoma in the Uterovesical Fold Presenting as a Uterine Fibroid. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2010.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Papa Dasari
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
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16
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Dutta S, Dasgupta C, Choudhury K. Paravaginal peripheral primitive neuroectodermal tumor: A rare tumor. Indian J Med Paediatr Oncol 2012; 32:171-3. [PMID: 22557788 PMCID: PMC3342728 DOI: 10.4103/0971-5851.92823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Peripheral primitive neuroectodermal tumor (PNET) of the female genital tract, particularly those in the vaginal and paravaginal region, are extremely rare. A 36-year-old woman presented with clinical features similar to that of a case of cervical fibroid. It was only after surgery that the histopathology suggested it to be a malignant round cell tumour and was CD99 positive. She underwent adjuvant chemotherapy with the Ifosfamide and Etoposide alternating with Vincristine, Doxorubicin, and Cyclophosphamide regime and radical radiotherapy. She is disease free at 12 months of follow-up. The importance of immunostaining and adequate histopathology report lies in the fact that the correct diagnosis thus achieved enabled us to manage a rare case of paravaginal PNET with a multimodality approach.
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Affiliation(s)
- Samrat Dutta
- Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
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17
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Masoura S, Kourtis A, Kalogiannidis I, Kotoula V, Anagnostou E, Angelidou S, Agorastos T. Primary primitive neuroectodermal tumor of the cervix confirmed with molecular analysis in a 23-year-old woman: A case report. Pathol Res Pract 2012; 208:245-9. [PMID: 22365564 DOI: 10.1016/j.prp.2012.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 12/03/2011] [Accepted: 01/11/2012] [Indexed: 11/19/2022]
Abstract
Primitive Neuroectodermal Tumor (PNET) of the genital tract is very rare, especially in the cervix. A case report of a young woman with a diagnosis of PNET originating from the uterine cervix is presented here. A 23-year-old woman presented with abnormal uterine bleeding and sharp lower abdominal pain of two months duration. CT and MRI of the abdomen and thorax revealed the presence of a large mass in the uterine cervix, enlarged pelvic lymph nodes and broncho-pulmonary infiltrations with regional nodes. Pathological examination of the tumor revealed a malignant neoplasm composed predominantly of small cells, immunohistochemically positive for CD99, vimentin and c-Kit. Molecular testing demonstrated the expression of EWS/FLI1 fusion transcripts corresponding to the t(11;22)(q24;q12) translocation, which confirmed the diagnosis of PNET of the uterine cervix. Despite surgical excision and administration of the first cycle of adjuvant chemotherapy, the patient died from multiple-organ failure and cardiac arrest. PNET arising from the genital tract, especially in the uterine cervix, is very rare and presents a diagnostic challenge. A timely confirmation with molecular analysis is essential for the diagnosis of such a tumor at an unusual site as in the present case.
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MESH Headings
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cervix Uteri/pathology
- Cervix Uteri/surgery
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Combined Modality Therapy
- DNA, Neoplasm/analysis
- Fatal Outcome
- Female
- Humans
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/therapy
- Oncogene Proteins, Fusion/genetics
- Pathology, Molecular
- Proto-Oncogene Protein c-fli-1/genetics
- RNA-Binding Protein EWS/genetics
- Translocation, Genetic
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/genetics
- Uterine Cervical Neoplasms/metabolism
- Uterine Cervical Neoplasms/therapy
- Young Adult
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Affiliation(s)
- Sophia Masoura
- 4th Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Farzaneh F, Rezvani H, Boroujeni PT, Rahimi F. Primitive neuroectodermal tumor of the cervix: a case report. J Med Case Rep 2011; 5:489. [PMID: 21962148 PMCID: PMC3197535 DOI: 10.1186/1752-1947-5-489] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 09/30/2011] [Indexed: 11/27/2022] Open
Abstract
Introduction Peripheral primitive neuroectodermal tumor of the cervix uteri is extremely rare. Between 1987 and 2010, there were only nine cases reported in the English literature, with considerably different management policies. Case presentation A 45-year-old Iranian woman presented to our facility with a primitive neuroectodermal tumor of the cervix uteri. Her clinical stage IB2 tumor was treated successfully with chemotherapy. Our patient underwent radical hysterectomy. There was no trace of the tumor after four years of follow-up. Conclusions According to current knowledge, primitive neuroectodermal tumors belong to the Ewing's sarcoma family, and the improvement of treatment outcome in our patient was due to dose-intensive neoadjuvant chemotherapy, surgery and consolidation chemotherapy in accordance with the protocol for bony Ewing's sarcoma.
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Affiliation(s)
- Farah Farzaneh
- Department of Medical Oncology, Taleghani Hospital, Tehran, Iran.
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19
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Rekhi B, Qureshi S, Basak R, Desai SB, Medhi S, Kurkure P, Menon S, Maheshwari A, Jambhekar NA. Primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old woman: a case report. J Med Case Rep 2010; 4:88. [PMID: 20233457 PMCID: PMC2848680 DOI: 10.1186/1752-1947-4-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 03/17/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Primary Ewing's sarcoma or primitive neuroectodermal tumor of the genital tract of women is uncommon. Rarer still is its occurrence in the vagina, with only five cases described so far. Out of these, only one case was confirmed using molecular analysis. Case presentation We present an extremely rare case of Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old Indian girl. She presented with a vaginal mass that was initially diagnosed as a malignant round cell tumor. Immunohistochemistry showed diffuse positivity for vimentin, membranous positivity for MIC2, and positivity for BCL2 and FLI-1. On the other hand, she was negative for cytokeratin, epithelial membrane antigen, desmin, Myo D-1, myogenin and smooth muscle actin. A diagnosis of primitive neuroectodermal tumor was thus offered. Furthermore, a molecular analysis of our patient using reverse transcription-polymerase chain reaction technique showed positivity for t(11; 22) (q24; q12) (EWSR1-FLI1), thus confirming the diagnosis of a Ewing's sarcoma/primitive neuroectodermal tumor. Our patient was offered chemotherapy on Institutional protocol EFT 2001. Conclusion This is a rare case of primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor, which was confirmed with molecular analysis, in the youngest patient known so far. This study reinforces the value of integrating morphological features with membranous MIC2 positivity, along with application of molecular techniques in objective identification of an Ewing's sarcoma or primitive neuroectodermal tumor at uncommon sites.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Dr EB Road, Parel, Mumbai, 400012, India.
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20
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Retroperitoneal primitive neuroectodermal tumour (PNET). A case report and review of the literature. Rep Pract Oncol Radiother 2009. [DOI: 10.1016/j.rpor.2009.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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21
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Primary vulvar Ewing's sarcoma/primitive neuroectodermal tumor in a post-menopausal woman: a case report. Pathol Res Pract 2009; 206:476-9. [PMID: 19656640 DOI: 10.1016/j.prp.2009.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 05/04/2009] [Accepted: 07/13/2009] [Indexed: 12/14/2022]
Abstract
Ewing's sarcomas/peripheral primitive neuroectodermal tumors (ES/pPNETs) are high-grade malignant neoplasms rarely found outside the skeletal system. Only 12 cases of vulvar ES/pPNET have so far been reported, all involving children or women of child-bearing age. We describe the case of a 52-year-old woman who was admitted to our hospital for the local excision of a 4cm vulvar mass, originally thought to be a Bartholin's gland cyst. It was subsequently found to consist of small round cells positive for anti-CD99 antibody, thus suggesting a diagnosis of ES/pPNET. The demonstration of EWSR1 gene translocations by means of fluorescent in situ hybridization excluded small-cell carcinoma, squamous cell carcinoma of the small type, Merkel cell carcinoma, and lymphoblastic lymphoma. After surgery, the patient received six cycles of polychemotherapy and radiotherapy; she is still alive and well after 1 year of follow-up. Our findings underline the crucial role of molecular biology techniques in the differential diagnosis of small round cell tumors in these unusual locations.
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22
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McCluggage WG, Sumathi VP, Nucci MR, Hirsch M, Dal Cin P, Wells M, Flanagan AM, Fisher C. Ewing family of tumours involving the vulva and vagina: report of a series of four cases. J Clin Pathol 2007; 60:674-80. [PMID: 17557870 PMCID: PMC1955083 DOI: 10.1136/jcp.2006.040931] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ewing's sarcoma and peripheral primitive neuroectodermal tumour (pPNET) are now regarded as two morphological ends of a spectrum of neoplasms, characterised by a t(11;22) or other related chromosomal translocation involving the EWS gene on chromosome 22 and referred to as Ewing family of tumours (EFTs). EFTs are extremely rare in the vulva and vagina, a review of the literature revealing only 13 previously reported possible cases, most of which have not had molecular confirmation. In this study, four new cases of EFTs involving the vulva (three cases) or vagina (one case) are reported. RESULTS The tumours occurred in women aged 19, 20, 30 and 40 years and ranged in size from 3 to 8 cm. Morphologically, all neoplasms had a lobulated architecture and were composed of solid aggregates of cells. In one case, occasional rosettes were formed. In all the tumours, there was diffuse membranous staining with CD99; nuclear positivity with FLI-1 was present in two cases. Three cases were focally positive with the broad-spectrum cytokeratin AE1/3, all were diffusely positive with vimentin and all were desmin negative. In two cases, a t(11;22) (q24;q12) (EWSR1-FLI-1) chromosomal translocation was demonstrated by reverse transcriptase-PCR (one case) and fluorescence in situ hybridisation (FISH) (one case), and in another case a rearrangement of the EWSR1 gene on chromosome 22 was demonstrated by FISH. In the other case, a variety of molecular studies did not reveal a translocation involving the EWS gene but this tumour, on the balance of probability, is still considered to represent a neoplasm in the EFTs. Follow-up in two cases revealed that one patient developed pulmonary metastasis and died and another is alive without disease at 12 months. CONCLUSIONS This report expands the published literature regarding EFTs involving the vulva and vagina and stresses the importance of molecular techniques in firmly establishing the diagnosis, especially when these neoplasms arise at unusual sites.
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MESH Headings
- 12E7 Antigen
- Adolescent
- Adult
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Cell Adhesion Molecules/metabolism
- Child
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 22/genetics
- Female
- Humans
- Immunoenzyme Techniques
- Microfilament Proteins/metabolism
- Middle Aged
- Neoplasm Proteins/metabolism
- Receptors, Cytoplasmic and Nuclear/metabolism
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/pathology
- Trans-Activators
- Translocation, Genetic
- Vaginal Neoplasms/genetics
- Vaginal Neoplasms/metabolism
- Vaginal Neoplasms/pathology
- Vulvar Neoplasms/genetics
- Vulvar Neoplasms/metabolism
- Vulvar Neoplasms/pathology
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland.
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23
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Abstract
As with biopsies from other sites in the female genital tract, immunohistochemistry is now being increasingly used in cervical pathology as an aid to diagnosis. In this review, I discuss applications of immunohistochemistry in diagnostic cervical pathology with a particular focus on recent developments. It is emphasised that immunohistochemistry is to be used as an adjunct to routine morphological examination and that no marker is totally specific or sensitive for a given lesion. Although much of this review focuses on glandular lesions, the value of markers, such as MIB1 and p16, in the assessment of pre-invasive cervical squamous lesions is discussed. In the broad field of cervical glandular lesions, topics covered include: the value of markers such as MIB1, p16 and bcl-2 in distinguishing adenocarcinoma in situ and glandular dysplasia from benign mimics; markers of mesonephric lesions, including CD10; markers of value in the diagnosis of minimal deviation adenocarcinoma, such as HIK1083; markers of value in distinguishing metastatic cervical adenocarcinoma in the ovary from primary ovarian endometrioid or mucinous adenocarcinoma. Rarely ectopic prostatic tissue occurs in the cervix, which can be confirmed by positive staining with prostatic markers. A panel of markers, comprising oestrogen receptor, vimentin, monoclonal carcinoembryonic antigen and p16, is of value in distinguishing between a cervical adenocarcinoma and an endometrial adenocarcinoma of endometrioid type. Markers of use in the diagnosis of cervical neuroendocrine neoplasms, including small cell and large cell neuroendocrine carcinoma, are discussed. It is stressed that small cell neuroendocrine carcinomas may be negative with most of the commonly used neuroendocrine markers and this does not preclude the diagnosis. p63, a useful marker of squamous neoplasms within the cervix, is of value in distinguishing small cell neuroendocrine carcinoma (p63 negative) from small cell squamous carcinoma (p63 positive) and in confirming that a poorly differentiated carcinoma is squamous in type.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospital Trust, Belfast, Northern Ireland.
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24
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Fadare O. Uncommon sarcomas of the uterine cervix: a review of selected entities. Diagn Pathol 2006; 1:30. [PMID: 16981999 PMCID: PMC1584249 DOI: 10.1186/1746-1596-1-30] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Accepted: 09/18/2006] [Indexed: 12/18/2022] Open
Abstract
Sarcomas constitute less than 1% of all cervical malignancies. With over 150 reported cases, rhabdomyosarcomas represent the most commonly reported sarcoma at this location. In this report, a select group of the more uncommon sarcomas of the uterine cervix are reviewed, including all previously reported examples of leiomyosarcoma, liposarcoma, alveolar soft part sarcoma, Ewing sarcoma/primitive neuroectodermal tumor, undifferentiated endocervical sarcoma, and malignant peripheral nerve sheath tumor (MPNST). Emphasis is placed on any distinctive clinicopathologic features of these entities at this unusual location.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, Wilford Hall Medical Center, Lackland AFB, San Antonio, TX, USA.
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25
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26
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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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27
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Snijders-Keilholz A, Ewing P, Seynaeve C, Burger CW. Primitive neuroectodermal tumor of the cervix uteri: A case report. Gynecol Oncol 2005; 98:516-9. [PMID: 15979131 DOI: 10.1016/j.ygyno.2005.05.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Accepted: 05/03/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peripheral primitive neuroectodermal tumor (PNET) of the cervix uteri is extremely rare. Between 1987 and 2002, there have been eight cases described in the English literature. The treatment policies in these eight cases differed considerably, partly due to the rarity of the disease and to differing time periods of diagnosis and treatment. CASE At the end of 2002, a 21-year-old woman presented with a PNET of the cervix uteri at our institute, the Erasmus Medical Center. For the appropriate treatment in this case, we reviewed the literature and decided that the treatment should be different from the local surgical treatment followed by additional treatments as most of the earlier reports describe. CONCLUSION In view of the current knowledge of PNET belonging to the family of Ewing's sarcoma, and the improvement of treatment outcome in these tumors due to dose-intensive neo-adjuvant chemotherapy, patients with PNET of the cervix should be treated in accordance to the protocol for bony Ewing's sarcoma with multimodality therapy by means of induction chemotherapy, surgery, and consolidation chemotherapy.
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Affiliation(s)
- A Snijders-Keilholz
- Erasmus University Medical Center, Daniel den Hoed Cancer Center, PO-Box 5201, 3008 AE Rotterdam, The Netherlands.
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28
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Primitive Neuroectodermal Tumor of the Uterus: A Case Report. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Odunsi K, Olatinwo M, Collins Y, Withiam-Leitch M, Lele S, Spiegel GW. Primary primitive neuroectodermal tumor of the uterus: a report of two cases and review of the literature. Gynecol Oncol 2004; 92:689-96. [PMID: 14766268 DOI: 10.1016/j.ygyno.2003.09.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2002] [Indexed: 11/21/2022]
Abstract
BACKGROUND Primary primitive neuroectodermal (pPNET) tumors rarely occur in adults, and they very rarely present as primary tumors of the uterus. Only 12 reported cases of pPNET of the uterus have been published in the English literature. We report two additional cases treated at the Roswell Park Cancer Institute, Buffalo, NY, between 1999 and 2002. CASES Two postmenopausal patients presenting with abnormal uterine bleeding underwent endometrial biopsy, and subsequently staging laparotomy. The diagnosis of pPNET in both cases was confirmed only by extensive immunohistochemical analysis of the tumors. One patient with disease confined to an endometrial polyp received no adjuvant therapy, while the second patient with extrauterine disease received adjuvant pelvic radiation followed by chemotherapy. CONCLUSIONS The diagnosis of pPNET of the uterus may be a challenge. Features of diagnostic significance include positive staining with neuron-specific enolase, presence of neurosecretory granules, and positive staining with the MIC-2 gene. Currently, there is no uniformity in the treatment of these cases since the majority of the patients reported to date have had surgery, chemotherapy, and/or radiation therapy.
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Affiliation(s)
- Kunle Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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30
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Gaona-Luviano P, Unda-Franco E, González-Jara L, Romero P, Medina-Franco H. Primitive neuroectodermal tumor of the vagina. Gynecol Oncol 2003; 91:456-8. [PMID: 14599885 DOI: 10.1016/s0090-8258(03)00500-6] [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: 11/22/2022]
Abstract
OBJECTIVES Primitive neuroectodermal tumor is grouped together with Ewing sarcoma of the bone, but its presentation includes a wider age range and more central locations than its osseous counterpart. Presentation in vagina is exceedingly rare. CASE A 34-year-old woman with personal history of kidney transplant presented with a painless vaginal mass. After surgical excision, pathology results demonstrated a primitive neuroectodermal tumor. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy. After 20 months postexcision, there is no clinical nor radiographic evidence of recurrence. CONCLUSIONS This is the second case of primitive neuroectodermal tumor located in the vagina reported in the literature.
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Affiliation(s)
- Patricia Gaona-Luviano
- Department of Gynecology, Nacional Institute of Medical Sciences and Nutrition "Salvador Zubirán," Mexico City, Mexico
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31
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O'Sullivan MJ, Perlman EJ, Furman J, Humphrey PA, Dehner LP, Pfeifer JD. Visceral primitive peripheral neuroectodermal tumors: a clinicopathologic and molecular study. Hum Pathol 2001; 32:1109-15. [PMID: 11679946 DOI: 10.1053/hupa.2001.28247] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ewing sarcoma-primitive neuroectodermal tumor (EWS/PNET) belongs to the group of pediatric small round blue cell tumors; although EWS/PNET is classically a tumor of the soft tissue or bone in children and young adults, individual cases have been described in patients of all ages. A group of chromosomal translocations involving the EWS gene and a member of the Ets transcription factor family of genes has been detected in EWS/PNET, and heterogeneity in the precise breakpoint of the translocation has been shown to generate a group of related fusion transcripts that may have prognostic significance. Within the last decade, the clinicopathologic spectrum of EWS/PNET has been markedly expanded by recognition that the tumor may also have a visceral origin. To determine whether visceral EWS/PNET has the same pattern of genetic alterations and range of fusion transcripts as EWS/PNET of bone and soft tissue, we performed reverse-transcription polymerase chain reaction-based testing of formalin-fixed, paraffin-embedded tissue from a series of visceral tumors for which the diagnosis of EWS/PNET was well established. Together with additional cases compiled from the literature, EWS-Fli1 (or a related fusion transcript) was present in 18 of 19 visceral EWS/PNET, with a distribution of transcript types not statistically different from EWS/PNET of soft tissue and bone (P >.05, chi(2) test). These results firmly establish the genetic relationship between EWS/PNET of visceral sites, soft tissue, and bone.
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MESH Headings
- Abdominal Neoplasms/chemistry
- Abdominal Neoplasms/genetics
- Abdominal Neoplasms/pathology
- Adolescent
- Adult
- Biomarkers, Tumor/analysis
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Female
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Neoplasm Proteins/analysis
- Neuroectodermal Tumors, Primitive, Peripheral/chemistry
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1
- RNA, Messenger/metabolism
- RNA, Neoplasm/analysis
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/chemistry
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Soft Tissue Neoplasms/chemistry
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Tomography, X-Ray Computed
- Transcription Factors/analysis
- Transcription Factors/genetics
- Viscera/pathology
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Affiliation(s)
- M J O'Sullivan
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St Louis, MO 63110, USA
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32
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Affiliation(s)
- A Afenyi-Annan
- Department of Pathology, University of Michigan Hospitals, Ann Arbor, MI 48109, USA
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33
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Abstract
BACKGROUND Primitive neuroectodermal tumors (PNETs) are rare and potentially aggressive malignancies. CASE A 24-year-old woman in her eighth week of pregnancy presented with a cervical mass. Tissue biopsy demonstrated poorly differentiated carcinosarcoma with neuroendocrine features. Immunohistochemical studies confirmed the diagnosis of PNET. Treatment included alternating courses of cyclophosphamide, adriamycin, vincristine (CAV) and ifosfamide, etoposide (IE). A radical hysterectomy with bilateral ovarian transposition and periaortic lymphadenectomy was performed with postoperative chemotherapy and radiotherapy. The patient remains disease free 2 years from therapy. CONCLUSION This is a rare case of cervical PNET occurring in a pregnant patient. A review of the literature indicates that cervical PNET is distinguishable from uterine PNET. This tumor affects younger women and may have a different histogenesis. Pregnancy should not delay diagnosis of this potentially aggressive tumor.
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Affiliation(s)
- A S Tsao
- Department of Internal Medicine, Indiana University, Indianapolis, Indiana 46202-5427, USA
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34
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Nielsen GP, Young RH. Mesenchymal tumors and tumor-like lesions of the female genital tract: a selective review with emphasis on recently described entities. Int J Gynecol Pathol 2001; 20:105-27. [PMID: 11293156 DOI: 10.1097/00004347-200104000-00002] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diverse mesenchymal tumors and tumor-like lesions that occur within the female genital tract include a number of lesions that have only been recently characterized and others about which there is new information. In this group are the aggressive angiomyxoma, angiomyofibroblastoma, and cellular angiofibroma. Criteria for the distinction of these lesions are reviewed, as are the pathologic features of prognostic significance in assessing smooth muscle tumors of the vulva. The diagnostic problems that the epithelioid variant of smooth muscle tumors, both benign and malignant, may pose when they occur in various areas of the genital tract are discussed, particularly with regard to problems encountered in the ovary, a site where the diagnosis often is not considered. Recent information expanding the morphologic spectrum of fibroepithelial polyps of the genital tract is presented, and important non-neoplastic entities, including nodular fasciitis and the postoperative spindle cell nodule, are reviewed. Mesenchymal tumors of the various types seen in the soft tissues may be encountered anywhere in the female genital tract and have been the subject of particular recent interest in the ovary; issues relevant to differential diagnosis are reviewed.
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Affiliation(s)
- G P Nielsen
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Department of Pathology, Fruit Street, Boston, MA 02114, USA
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35
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36
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Sinkre P, Albores-Saavedra J, Miller DS, Copeland LJ, Hameed A. Endometrial endometrioid carcinomas associated with Ewing sarcoma/peripheral primitive neuroectodermal tumor. Int J Gynecol Pathol 2000; 19:127-32. [PMID: 10782408 DOI: 10.1097/00004347-200004000-00005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Three uterine tumors, each consisting of endometrioid carcinoma and Ewing's sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) are described. The diagnosis of ES/pPNET in each case was first established in the hysterectomy specimen because each ES/pPNET was misinterpreted on the endometrial biopsy specimens as a high-grade homologous sarcoma. The ES/pPNET element in each case consisted of solid masses of small- to medium-sized round cells without Homer-Wright pseudorosettes, glial or ganglion cells, true rosettes with central lumens, or medulloepithelial tubules. Each ES/pPNET exhibited focal positive immunostaining for neuron-specific enolase, diffuse staining for vimentin, and strong cell membrane immunoreactivity for O13 (CD99), the last finding providing the first clue to the diagnosis of ES/pPNET in each case. The diagnosis in each case was confirmed by detection of EWS/FLI-1 fusion transcript through reverse transcription polymerase chain reaction. We also examined O13 immunoreactivity retrospectively in 40 cases of malignant mixed mullerian tumors (MMMT) with homologous or heterologous elements. O13 immunoreactivity was not observed in the malignant epithelium or in the homologous or heterologous sarcomas. The immunoreactivity of O13 in round cell endometrial sarcomas provides a clue to the diagnosis of ES/pPNET.
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MESH Headings
- 12E7 Antigen
- Aged
- Antigens, CD/analysis
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/pathology
- Cell Adhesion Molecules/analysis
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/pathology
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Mixed Tumor, Mullerian/diagnosis
- Mixed Tumor, Mullerian/pathology
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/pathology
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1
- RNA, Messenger/analysis
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Transcription Factors/genetics
- Uterine Neoplasms/diagnosis
- Uterine Neoplasms/pathology
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Affiliation(s)
- P Sinkre
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9073, USA
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37
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Vang R, Taubenberger JK, Mannion CM, Bijwaard K, Malpica A, Ordonez NG, Tavassoli FA, Silver SA. Primary vulvar and vaginal extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor: diagnostic confirmation with CD99 immunostaining and reverse transcriptase-polymerase chain reaction. Int J Gynecol Pathol 2000; 19:103-9. [PMID: 10782405 DOI: 10.1097/00004347-200004000-00002] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two cases of extraosseous Ewing's sarcoma/peripheral neuroectodermal tumor arising in unusual, superficial sites are reported. One tumor involved the vaginal wall of a 35-year-old woman, and the other neoplasm arose in the dermis of the vulva in a 28-year-old woman. The tumors showed characteristic microscopic features of Ewing's sarcoma/peripheral neuroectodermal tumor with nodular monotonous proliferations of undifferentiated, small, round, hyperchromatic cells with a low mitotic index. Rare rosette-like formations were apparent only in the vulvar neoplasm. The tumors displayed intense immunoreactivity in a membranous pattern for CD99, the cell surface glycoprotein encoded by the MIC2 gene. Genetically, the tumors expressed the EWS/FLI-1 chimeric transcript, derived from the t(11;22)(q24;q12) chromosomal translocation. Both patients had localized disease treated with wide local excision; one received postoperative chemotherapy, and the other received chemotherapy and radiotherapy. To date, 18 and 19 months after diagnosis, neither patient has had clinical evidence of local recurrence or metastasis. To our knowledge, these are the first reported cases of vaginal and vulvar Ewing's sarcoma/peripheral neuroectodermal tumor, confirmed with molecular genetic analysis, in the English literature.
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MESH Headings
- 12E7 Antigen
- Adult
- Antigens, CD/analysis
- Antineoplastic Agents/therapeutic use
- Cell Adhesion Molecules/analysis
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Female
- Humans
- Immunohistochemistry
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/genetics
- Neuroectodermal Tumors/therapy
- Radiotherapy
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/therapy
- Surgical Procedures, Operative
- Translocation, Genetic
- Vaginal Neoplasms/diagnosis
- Vaginal Neoplasms/genetics
- Vaginal Neoplasms/therapy
- Vulvar Neoplasms/diagnosis
- Vulvar Neoplasms/genetics
- Vulvar Neoplasms/therapy
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Affiliation(s)
- R Vang
- Department of Pathology, University of Texas Medical School, Houston, USA
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