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Ezzdean W, Swed S, Almoshantaf MB, Sawaf B, Orab T. A large femoral primary cutaneous Ewing's sarcoma in a 35-year-old woman: Case report. Int J Surg Case Rep 2021; 88:106520. [PMID: 34741853 PMCID: PMC8577428 DOI: 10.1016/j.ijscr.2021.106520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Extraskeletal Ewing's sarcoma is a rare malignant tumor of mesenchymal origin, which is histologically similar to primary osseous Ewing's sarcoma. It has been well described in deep soft tissues. However, location in cutaneous or subcutaneous tissue has rarely been reported. Being seen principally in children, it can be seen, rarely, in old men. CASE PRESENTATION We present a case of large primary cutaneous Ewing sarcoma within the left thigh of a 35-year-old woman, without osseous involvement. Physical examination. Histologically, it was a small round cell tumor that marked strongly for CD99. The diagnosis of cutaneous Ewing sarcoma was performed. DISCUSSION The things that distinguish our case are that it is the first case in Syria, in addition to the size of the large tumor with diameters of 15 × 20 cm, and it is in a 35-year-old woman. CONCLUSION Ewing sarcoma is a rare malignant small round cell tumor of the skin and subcutaneous tissue. It should be differentiated from other cutaneous neoplasms composed of small round cells.
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Affiliation(s)
- Weaam Ezzdean
- Department of Urology, Ibn Al Nafees, Damascus, Syria
| | - Sarya Swed
- Faculty of Human Medicine, Aleppo University, Aleppo, Syria.
| | | | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Talal Orab
- Department of General Surgery, Ibn Al Nafees, Damascus, Syria
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2
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Evangelou Z, Zhang L, Tafe LJ, Azzouz L, Grada Z, Linos K. Primary cutaneous Ewing sarcoma with diffuse S100/SOX10 positivity and pseudoalveolar pattern: An extraordinarily rare case highlighting a potential pitfall with significant repercussions. J Cutan Pathol 2020; 48:302-308. [PMID: 32592167 DOI: 10.1111/cup.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
Primary cutaneous Ewing sarcoma is a very rare entity with less than 100 cases reported in the literature, sharing the same morphological and immunohistochemical characteristics as their osseous counterparts. Herein, to the best of our knowledge, we report the first case in English literature of a molecularly confirmed Ewing sarcoma with diffuse and strong SOX10 immunoreactivity. This exceedingly rare immunohistochemical finding along with the rarity of this tumor could easily lead to a misdiagnosis with significant repercussions. Our case highlights the difficulty in diagnosing primary cutaneous Ewing sarcoma as well as the pivotal role molecular diagnostics can play in specific scenarios.
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Affiliation(s)
- Zoi Evangelou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Linsheng Zhang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura J Tafe
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Lubna Azzouz
- Department of Pathology, Tripoli Medical Center, Tripoli, Libya
| | - Zakaria Grada
- Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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3
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Al-Ibraheemi A, Kozakewich H, Perez-Atayde AR. Selected Diagnostically Challenging Pediatric Soft Tissue Tumors. Surg Pathol Clin 2016; 8:399-418. [PMID: 26297063 DOI: 10.1016/j.path.2015.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many benign and malignant soft tissue tumors in children are challenging and their diagnosis requires knowledge of their vast diversity, histopathological complexity, and immunohistochemical, cytogenetic, and molecular characteristics. The importance of clinical and imaging features cannot be overstated. Soft tissue sarcomas account for 15% of all pediatric malignancies after leukemia/lymphoma, central nervous system tumors, neuroblastoma and Wilms tumor. This article discusses selected challenging pediatric soft tissue tumors with an update on recently described entities.
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Affiliation(s)
- Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Harry Kozakewich
- Department of Pathology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Antonio R Perez-Atayde
- Department of Pathology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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Qi W, Deng X, Liu T, Hou Y, Yang C, Wu L, Fang J, Tong X, Yang J, Xu Y. Comparison of Primary Spinal Central and Peripheral Primitive Neuroectodermal Tumors in Clinical and Imaging Characteristics and Long-Term Outcome. World Neurosurg 2015; 88:359-369. [PMID: 26748171 DOI: 10.1016/j.wneu.2015.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Primary spinal primitive neuroectodermal tumors are extremely rare entities. The purpose of this study was to analyze the differences in clinical and imaging characteristics and outcomes between primary spinal central PNETs (cPNETs) and peripheral PNETs (pPNETs). METHODS There were 25 consecutive patients with primary spinal primitive neuroectodermal tumors enrolled. The diagnosis was cPNET in 6 patients with negative CD99 expression and pPNET in 19 patients with positive CD99 expression. Gross total resection (GTR) was achieved in 12 patients, subtotal resection was performed in 9 patients, and partial resection was performed in 4 patients. Postoperative chemotherapy was given to 14 patients, and radiotherapy was given to 16 patients. RESULTS The age at diagnosis was significantly younger in the cPNET group (mean 12.8 years) compared with the pPNET group (mean 22.5 years) (P = 0.040); the 2 pathologies did not show a significant difference in prognosis. GTR (P = 0.041), radiotherapy (P = 0.008), and GTR with radiotherapy (P = 0.009) were significant factors leading to a higher 2-year survival rate. Kaplan-Meier analysis showed that radiotherapy (P < 0.001) and GTR with radiotherapy (P = 0.040) resulted in a longer median survival time. Patients who underwent GTR, chemotherapy, and radiotherapy all together had the highest 1-year (100.0%) and 2-year (71.4%) survival rates and the longest median survival time (32 months). CONCLUSIONS Patients with spinal cPNETs were younger compared with patients with pPNETs. The prognosis of spinal cPNETs and pPNETs was poor with no significant difference between the entities. The most beneficial treatment modality is GTR combined with adjuvant radiotherapy and chemotherapy.
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Affiliation(s)
- Wei Qi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tie Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingzhi Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chenlong Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyi Fang
- Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xianzeng Tong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yulun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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5
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Magro G, Longo FR, Angelico G, Spadola S, Amore FF, Salvatorelli L. Immunohistochemistry as potential diagnostic pitfall in the most common solid tumors of children and adolescents. Acta Histochem 2015; 117:397-414. [PMID: 25881477 DOI: 10.1016/j.acthis.2015.03.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/19/2015] [Accepted: 03/25/2015] [Indexed: 12/11/2022]
Abstract
Making a correct diagnosis when dealing with a small round blue cell tumor (SRBCT) of children and adolescents may be relatively straightforward if the tumor arises in the typical clinical setting and the classic pathologic features are all recognizable. However it is widely known that diagnostic difficulties may arise because of: (i) many tumors share overlapping morphological and/or immunohistochemical features; (ii) considerable clinical, pathologic, and immunohistochemical variations do exist; (iii) the increasing use of small biopsies in daily practice makes the diagnosis of these neoplasms more challenging. Accordingly, immunohistochemical analyses are currently mandatory in establishing the correct diagnosis. In this regard there is the need to identify more sensitive and specific immunomarkers useful in the distinction of the several tumor entities. Over the last decades, several markers, such as CD99, WT1 protein, desmin, myogenin, NB84, and INI1 have been identified, providing a considerable help in recognition of the most common solid tumors (ESW/pPNET, rhabdomyosarcoma, neuroblastoma, Wilms' tumor, desmoplastic small round cell tumor; malignant rhabdoid tumor) in children and adolescents. However, at the same time, their unusual, unexpected expression can result in a misinterpretation of the immunohistochemical results, especially by pathologists who are not familiar with oncologic pediatric pathology. Therefore the present review focuses on the potential immunohistochemical pitfalls which should be kept in mind by pathologists to prevent diagnostic errors when dealing with SRBCTs.
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Affiliation(s)
- Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, University of Catania, Catania, Italy.
| | - Francesca Romana Longo
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, University of Catania, Catania, Italy
| | - Giuseppe Angelico
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, University of Catania, Catania, Italy
| | - Saveria Spadola
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, University of Catania, Catania, Italy
| | - Flavia Francesca Amore
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, University of Catania, Catania, Italy
| | - Lucia Salvatorelli
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, University of Catania, Catania, Italy
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Abstract
Because of the large number of different tissues making up the distal phalanx of fingers and toes, a large variety of malignant tumors can be found in and around the nail apparatus. Bowen disease is probably the most frequent nail malignancy. It is usually seen as a verrucous plaque of the nail fold and nail bed in persons above the age of 40 years. It slowly grows over a period of years or even decades before degenerating to an invasive squamous cell carcinoma. The latter may also occur primarily often as a weeping onycholysis. The next most frequent nail malignancy is ungual melanoma. Those arising from the matrix are usually pigmented and often start with a longitudinal melanonychia whereas those originating from the nail bed remain amelanotic, are often nodular and mistaken for an ingrown nail in an elderly person. The treatment of choice for in situ and early invasive subungual melanomas is generous extirpation of the nail apparatus whereas distal amputation is only indicated for advanced melanomas. In addition to these frequent nail malignancies, nail-specific carcinomas, malignant vascular and osseous tumors, other sarcomas, nail involvement in malignant systemic disorders and metastases may occur. In most cases, they cannot be diagnosed accurately on clinical grounds. Therefore, a high degree of suspicion is necessary in all isolated or single-digit proliferations that do not respond to conservative treatment.
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Affiliation(s)
- E Haneke
- Dermaticum Freiburg, Schlippehof 5, 79110, Freiburg, Deutschland,
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Oliveira Filho JD, Tebet ACF, Oliveira ARFMD, Nasser K. Primary cutaneous Ewing sarcoma--case report. An Bras Dermatol 2014; 89:501-3. [PMID: 24937829 PMCID: PMC4056713 DOI: 10.1590/abd1806-4841.20142881] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/17/2013] [Indexed: 11/26/2022] Open
Abstract
Ewing sarcoma is a primitive neuroectodermal tumor rarely occurs in the skin and
sobcutaneous tissues. Generally Ewing's sarcoma is a primary bone tumor, but
when present in soft tissues it characterizes an extremely uncommon clinical
picture. It usually involves the deep subcutaneous tissue or muscles, and more
rarely occurs like a primary skin cancer. Most patients are white, women, and in
the second decade of life. The clinical features are a superficial mass, in
average measuring 2-3 cm, of soft consistency, freely mobile and sometimes
painful. The more affected locations are upper and lower extremities, trunk,
head, neck or multiple lesions. The presence of metastases is very rare.
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8
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Peripheral primitive neuroectodermal tumor/primary cutaneous Ewing’s sarcoma (PPNET/ES) of the upper eyelid in an adult patient. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Arnold MA, Ballester LY, Pack SD, Abdullaev Z, Merchant M, Tsokos MG. Primary subcutaneous spindle cell Ewing sarcoma with strong S100 expression and EWSR1-FLI1 fusion: a case report. Pediatr Dev Pathol 2014; 17:302-7. [PMID: 24735198 DOI: 10.2350/14-03-1454-cr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ewing sarcoma is described classically as a small, round cell tumor of bone and soft tissue in children and young adults. Ewing sarcoma most often is characterized by a fusion of the Ewing sarcoma breakpoint region 1 (EWSR1) and the Friend leukemia virus integration 1 (FLI1) genes, forming an EWSR1-FLI1 fusion transcript. We report an exceptional case of primary subcutaneous Ewing sarcoma in a 16-year-old female composed entirely of spindle cells with focal fascicular growth and exhibiting strong, diffuse immunohistochemical reactivity for S100, unlike classic Ewing sarcoma. However, reverse transcription-polymerase chain reaction (RT-PCR) analysis confirmed the presence of a rare variant of the EWSR1-FLI1 fusion transcript, featuring fusion of EWSR1 exon 10 to FLI1 exon 6. To our knowledge, the combined histologic, molecular, and clinical features have not been reported previously in Ewing sarcoma, and raise a broad differential diagnosis emphasizing the importance of molecular techniques in the diagnosis of this tumor.
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Affiliation(s)
- Michael A Arnold
- 1 Department of Pathology and Laboratory Medicine, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
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10
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Machado I, Traves V, Cruz J, Llombart B, Navarro S, Llombart-Bosch A. Superficial small round-cell tumors with special reference to the Ewing's sarcoma family of tumors and the spectrum of differential diagnosis. Semin Diagn Pathol 2013; 30:85-94. [DOI: 10.1053/j.semdp.2012.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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11
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43 year old male with a right pelvic mass. ACTA ACUST UNITED AC 2012; 8:225-6. [PMID: 22440360 DOI: 10.1016/j.reuma.2011.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/18/2011] [Accepted: 09/19/2011] [Indexed: 11/23/2022]
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12
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Cutaneous Ewing sarcoma: report of 2 cases and literature review of presentation, treatment, and outcome of 76 other reported cases. J Pediatr Hematol Oncol 2011; 33:631-4. [PMID: 22042282 DOI: 10.1097/mph.0b013e31821b234d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous Ewing sarcoma is a rare variant that has been poorly characterized and has no standard therapy. We report 2 patients with cutaneous Ewing sarcoma and review 76 other cases reported in the literature for demographics, presentation, treatment, and outcome. Only 2 patients presented with metastatic disease, and only 8 patients developed metastatic disease. Ninety-one percent of all patients are alive despite wide variations in treatment regimens. On the basis of this summary, treatment consisting of local control with surgery and/or radiation and abbreviated chemotherapy is proposed as a treatment option for this less aggressive Ewing sarcoma.
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Gupta N, Chand T, Yadav N, Kumar R, Chauhan DS, Chaudhary P, Arora MP. Extraosseous Ewing's tumor of lateral abdominal wall. Clin Pract 2011; 1:e135. [PMID: 24765376 PMCID: PMC3981408 DOI: 10.4081/cp.2011.e135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 10/19/2011] [Accepted: 11/02/2011] [Indexed: 11/23/2022] Open
Abstract
Extraosseous Ewings tumor (EES) is a rare entity. Few cases have been reported in literature. There are no specific guidelines for management of this disease. We are reporting a case of EES arising from left lateral abdominal wall. We did wide excision of tumor followed by chemoradiation. Patient is asymptomatic after 8 months of follow up.
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Affiliation(s)
- Nikhil Gupta
- Department of Surgery, Lady Hardinge Medical College, Delhi, India
| | - Tirlok Chand
- Department of Surgery, Lady Hardinge Medical College, Delhi, India
| | - Nidhi Yadav
- Department of Surgery, Lady Hardinge Medical College, Delhi, India
| | - Rajeev Kumar
- Department of Surgery, Lady Hardinge Medical College, Delhi, India
| | | | - Poras Chaudhary
- Department of Surgery, Lady Hardinge Medical College, Delhi, India
| | - Mohinder P Arora
- Department of Surgery, Lady Hardinge Medical College, Delhi, India
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14
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Machado I, Llombart B, Calabuig-Fariñas S, Llombart-Bosch A. Superficial Ewing's sarcoma family of tumors: a clinicopathological study with differential diagnoses. J Cutan Pathol 2011; 38:636-43. [DOI: 10.1111/j.1600-0560.2011.01705.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Primary cutaneous Ewing sarcoma/primitive neuroectodermal tumour: a clinicopathological analysis of seven cases highlighting diagnostic pitfalls and the role of FISH testing in diagnosis. J Clin Pathol 2009; 62:915-9. [DOI: 10.1136/jcp.2008.064014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims:To perform a clinicopathological analysis of a series of primary cutaneous Ewing sarcomas/primitive neuroectodermal tumours (ES/PNET) to highlight the pathological features, discuss the differential diagnosis, emphasise the role of molecular testing (particularly fluorescence in situ hybridisation, FISH) in diagnosis and outline the patients’ clinical course.Methods:Seven cases of primary cutaneous ES/PNET were identified from the authors’ consultation files.Results:The patients were aged 16–61 years (median 25). Five were female and two were male. Five cases involved the limbs and two the trunk. Five were initially misdiagnosed (three as carcinoma and two as melanoma). All cases were characterised histologically by sheet-like growth of small round cells with little cytoplasm and showed strong membranous staining for CD99 and positive but variable staining for FLI-1. Six patients showed an EWS rearrangement (five on FISH analysis and one on RT-PCR). All tumours were completely excised. Three patients received adjuvant chemotherapy, one of whom also received radiotherapy. Follow-up was available in all cases (range 11–57 months; median 41). No recurrences or metastases occurred.Conclusions:Although rare, primary cutaneous ES/PNET should be considered in the differential diagnosis of cutaneous “small blue cell tumours”. Immunostaining for FLI-1 and molecular testing for evidence of an EWS rearrangement are useful ancillary investigations to confirm the diagnosis. The prognosis of primary cutaneous ES/PNET appears to be more favourable than extracutaneous ES/PNET.
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16
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A Malignant Cutaneous Neuroendocrine Tumor With Features of Merkel Cell Carcinoma and Differentiating Neuroblastoma. Am J Dermatopathol 2009; 31:193-6. [DOI: 10.1097/dad.0b013e31819114c4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Quddus MR, Rashid L, Sung CJ, Steinhoff MM, Cunxian Zhang, Lawrence WD. Ewing's Sarcoma / Peripheral Primitive Neuroectodermal Tumor (ES/PNET) Differentiation in Endometrial Serous Carcinomas. Reprod Sci 2009; 16:591-5. [DOI: 10.1177/1933719109332824] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Ruhul Quddus
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island,
| | - Lanita Rashid
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - C. James Sung
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Margaret M. Steinhoff
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cunxian Zhang
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - W. Dwayne Lawrence
- Department of Pathology & Laboratory Medicine, Women & Infants Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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18
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Terrier-Lacombe MJ, Guillou L, Chibon F, Gallagher G, Benhattar J, Terrier P, Ranchère D, Coindre JM. Superficial primitive Ewing's sarcoma: a clinicopathologic and molecular cytogenetic analysis of 14 cases. Mod Pathol 2009; 22:87-94. [PMID: 18820660 DOI: 10.1038/modpathol.2008.156] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Superficial primitive Ewing's sarcomas are rare and have been reported to be of favorable prognosis compared to conventional deep-seated tumors. In the skin and subcutis, the diagnosis is often difficult, and performing molecular cytogenetic techniques may be helpful. We performed a retrospective analysis of 14 cases of superficial Ewing's sarcomas, all confirmed by molecular cytogenetics. Clinical, histological, immunohistochemical, molecular cytogenetic, therapeutic, and follow-up data are reported. There were 11 female and 3 male patients aged from 12 to 77 years (median: 17 years). Seven tumors occurred in the extremities, five in the trunk wall, and two in the head. Tumor size ranged from 1 to 5 cm (median, 3 cm). They were all small round-cell proliferations with a strong membranous positivity for CD99. Ewing's sarcoma translocations/fusion gene transcripts were detected in eight cases, both by FISH and reverse transcriptase (RT)-PCR. Four tumors were positive by RT-PCR alone (FISH not done in three cases and not interpretable in one case), and two cases were positive by FISH alone (RT-PCR not done). Surgical resection was performed in all patients. Chemotherapy was given in ten patients and radiotherapy in six. At last medical examination (median follow-up, 47 months), two patients who underwent surgical resection alone had died from the tumor. Our results confirm that superficial Ewing's sarcomas are of good prognosis. Given the difficulty of the diagnosis and the importance of an adapted treatment, a confirmation of the diagnosis by molecular or cytogenetic techniques is recommended when dealing with a superficial tumor.
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19
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Cabrera R, Sánchez P, Rodríguez M. Tumor subcutáneo neuroectodérmico primitivo periférico. A propósito de un caso. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74741-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Cabrera R, Sánchez P, Rodríguez MA. [Case report of a subcutaneous peripheral primitive neuroectodermal tumor]. ACTAS DERMO-SIFILIOGRAFICAS 2008; 99:555-9. [PMID: 18682169 DOI: 10.1016/s1578-2190(08)70313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Peripheral primitive neuroectodermal tumors - also known as Ewing sarcomas - are a rare type of malignant tumor the histology of which characteristically reveals the presence of small round cells. Typically, t(11;22) translocation is observed. We describe the case of a 45-year-old man with a subcutaneous peripheral primitive neuroectodermal tumor in which the t(11;22) translocation was detected. He was satisfactorily treated with surgery and radiotherapy.
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Affiliation(s)
- R Cabrera
- Servicio de Dermatología. Complejo Asistencial de León. León. España.
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21
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Ehrig T, Billings SD, Fanburg-Smith JC. Superficial primitive neuroectodermal tumor/Ewing sarcoma (PN/ES): same tumor as deep PN/ES or new entity? Ann Diagn Pathol 2007; 11:153-9. [PMID: 17498589 DOI: 10.1016/j.anndiagpath.2006.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primitive neuroectodermal tumor/Ewing sarcoma (PN/ES) is a single clinical, morphologic, and molecular small round cell tumor entity. These are generally found in deep soft tissue or bone of young male patients, with poor behavior. Location in dermis is unexpected; only rare cases are reported. Cases coded as "dermal," "cutaneous," or "skin" PN/ES were retrieved from our consultation files. Only primary dermal cases were included. Those otherwise diagnosed or with incomplete material were excluded. There were 13 dermal PN/ES cases, consisting of 10 women and 3 men. Ages ranged from 2 to 67 years (mean, 28 years). Locations included groin or thigh (4), back or shoulder (3), neck (1), chest (1), scalp (1), forehead (1), hand (1), and foot (1). Most cases were small (0.5-2.3 centimeters) and painful, and persisted for less than 1 year. All were located within the dermis. Three caused pedunculation; 9 also involved superficial subcutis. All but 1 of the metastasizing tumors were round and encapsulated. All were composed of round to oval cells with a vague rosetting pattern, slightly overlapping nuclei, finely stippled chromatin, clear to eosinophilic cytoplasm, and collagenous stroma. Median mitotic activity was 8 per 10 high-power fields. Necrosis was present in three cases. All had globular periodic acid Schiff positivity and distinctive cytoplasmic membrane CD99 reactivity. One case studied was positive for Fli-1. All were negative for leukocyte common antigen, Tdt, CD3, CD20, CD79, CK20, pankeratin, epithelial membrane antigen, chromogranin, neurofilament protein, carcinoembryonic antigen, desmin, actin, diffuse S100 protein, and HMB45. Nine cases with material for reverse transcription-polymerase chain reaction revealed 1 positive type 2 translocation (EWS exon 7 to Fli-1 exon 5), 4 negative, and 4 "unable to amplify." Treatment was by wide excision; 9 received chemotherapy and 6 radiation. Follow-up of 11 (85%) cases revealed the following: 1 metastasis to stomach and death at 3 years; 10 years without disease (median, 9.0 years). Cutaneous PN/ES is a superficial round cell tumor in older women, with better prognosis than deep PN/ES. These may have a hitherto unrecognized variant genetic abnormality.
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MESH Headings
- 12E7 Antigen
- Adolescent
- Adult
- Aged
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Cell Adhesion Molecules/genetics
- Cell Adhesion Molecules/metabolism
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Middle Aged
- Neuroectodermal Tumors/diagnosis
- Neuroectodermal Tumors/genetics
- Neuroectodermal Tumors/pathology
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/pathology
- Prognosis
- Retrospective Studies
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sex Characteristics
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Vimentin/genetics
- Vimentin/metabolism
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Affiliation(s)
- Torsten Ehrig
- Dermatopathology Laboratory of New England, Meriden, CT 06450, USA
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22
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Mangham DC, Williams A, McMullan DJ, McClure J, Sumathi VP, Grimer RJ, Davies AM. Ewing's sarcoma of bone: the detection of specific transcripts in a large, consecutive series of formalin-fixed, decalcified, paraffin-embedded tissue samples using the reverse transcriptase-polymerase chain reaction. Histopathology 2006; 48:363-76. [PMID: 16487358 DOI: 10.1111/j.1365-2559.2006.02318.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS (i) To report on the routine use of the reverse transcriptase-polymerase chain reaction (RT-PCR) technique on decalcified or non-decalcified, formalin-fixed, paraffin-embedded tissue (FFPET) for translocation detection, with particular emphasis on improved RNA extraction methodology and the use of PCR primers designed to generate small amplicons. (ii) To report on the relative incidences of translocation types and transcript variants in a large, single institution series of Ewing's sarcoma of bone. METHODS AND RESULTS Using RT-PCR to detect specific transcript variants, we analysed FFPET from 54 consecutive cases of Ewing's sarcoma of bone. We used 'gold standard' detection methods on corresponding fresh and fresh frozen tissue to validate the technique. We have demonstrated the effective use of RT-PCR on decalcified and non-decalcified FFPET samples for sarcoma-specific translocation detection (96% sensitivity, 100% specificity). Tissue decalcification did not affect the detection rate. The relative incidence of Ewing's sarcoma-specific translocation types and transcript variants was entirely consistent with previously published data. CONCLUSIONS With equal effectiveness, RT-PCR can be applied to both acid decalcified and non-decalcified FFPET for (Ewing's sarcoma) translocation detection and the technique can be introduced into routine practice in histopathology departments.
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Affiliation(s)
- D C Mangham
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital, The Medical School, University of Birmingham, Birmingham, UK.
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23
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Ho KC, Ng KK, Yen TC, Chou HH. An ovary in luteal phase mimicking common iliac lymph node metastasis from a primary cutaneous peripheral primitive neuroectodermal tumour as revealed by 18-fluoro-2-deoxyglucose positron emission tomography. Br J Radiol 2005; 78:343-5. [PMID: 15774596 DOI: 10.1259/bjr/95232584] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 30-year-old female underwent surgical removal of a primary cutaneous peripheral primitive neuroectodermal tumour (PNET) of the left thigh. A subsequent 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) scan showed abnormal accumulation of FDG in the left upper pelvic region, consistent with metastasis to a left common iliac node. A series of follow-up imaging studies revealed that a cyst of the corpus luteum of ovary was responsible for the abnormal FDG accumulation.
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Affiliation(s)
- K-C Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
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24
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Somers GR, Shago M, Zielenska M, Chan HSL, Ngan BY. Primary subcutaneous primitive neuroectodermal tumor with aggressive behavior and an unusual karyotype: case report. Pediatr Dev Pathol 2004; 7:538-45. [PMID: 15547779 DOI: 10.1007/s10024-004-2024-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 05/17/2004] [Indexed: 10/26/2022]
Abstract
Primitive neuroectodermal tumor/Ewing sarcoma (PNET/ES) rarely occurs in the skin and subcutaneous tissues. We present a case of a 16-year-old girl with primary cutaneous and subcutaneous PNET/ES of the abdominal wall. Despite wide local excision and chemotherapy, she rapidly developed cranial bone and brain metastases, followed by lung and skeletal metastases, and died shortly thereafter. The recurrent tumor exhibited light microscopic features of a small, round, blue cell tumor with intracytoplasmic glycogen. Immunohistochemical analysis showed positivity for CD99, CD56, S100, and glial fibrillary acid protein, and ultrastructural features included cytoplasmic glycogen and focal complex interdigitating synaptic junction-like cytoplasmic folds. Cytogenetic analysis of the relapsed tumor showed a complex karyotype: 47,XX,i(1)(q10), der(4)t(4;19) (q33 approximately q35;q13.1), + 8,t(15;17)(q24;p11.2 approximately p12),der(19)t (19;20)(q13.1;p11.2),der(22)t(20;22)(q13;q13). Cytogenetic, interphase fluorescence in situ hybridization, and molecular genetic analyses failed to show t(11:22) (q24;q12) or abnormalities of chromosome region 22q12. The clinical behavior and atypical and complex cytogenetic abnormalities exhibited by the tumor in this patient are unusual and represent the most aggressive end of the clinical spectrum of cutaneous and subcutaneous PNET/ES.
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MESH Headings
- Adolescent
- Biomarkers, Tumor/analysis
- Bone Neoplasms/secondary
- Brain Neoplasms/metabolism
- Brain Neoplasms/secondary
- Chromosome Aberrations
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Lung Neoplasms/secondary
- Microscopy, Electron, Transmission
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/metabolism
- Neuroectodermal Tumors, Primitive, Peripheral/secondary
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/metabolism
- Sarcoma, Ewing/pathology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/metabolism
- Soft Tissue Neoplasms/pathology
- Subcutaneous Tissue/pathology
- Subcutaneous Tissue/ultrastructure
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Affiliation(s)
- Gino R Somers
- Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, M5G 1X8, Toronto, ON, Canada.
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25
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Hill DA, O'Sullivan MJ, Zhu X, Vollmer RT, Humphrey PA, Dehner LP, Pfeifer JD. Practical application of molecular genetic testing as an aid to the surgical pathologic diagnosis of sarcomas: a prospective study. Am J Surg Pathol 2002; 26:965-77. [PMID: 12170083 DOI: 10.1097/00000478-200208000-00001] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The strong correlation of specific reciprocal translocations with individual tumor types and the demonstration that polymerase chain reaction (PCR)-based methods can detect translocations in tissue samples have stimulated interest in the role of molecular genetic testing in diagnostic surgical pathology. To evaluate the clinical utility of PCR-based molecular analysis of soft tissue neoplasms in routine surgical pathology, 131 consecutive soft tissue tumors submitted for molecular genetic testing at a tertiary care teaching hospital were prospectively analyzed over a 36-month period. RT-PCR was used to test tumor RNA for fusion transcripts characteristic of malignant round cell tumors (including Ewing sarcoma/primitive neuroectodermal tumor, desmoplastic small round cell tumor, and alveolar rhabdomyosarcoma), spindle cell tumors (including synovial sarcoma and congenital fibrosarcoma), and fatty tumors (myxoid liposarcoma). DNA sequence analysis was used to confirm the identity of all PCR products, and the PCR results were compared with the histopathologic diagnosis. We found that sufficient RNA for RT-PCR-based testing was recovered from 96% of the 131 cases and the percentage of tumors that tested positive for the associated characteristic fusion transcript was in general agreement with those reported in the literature. DNA sequence analysis of PCR products identified both variant transcripts and spurious PCR products, underscoring the value of product confirmation steps when testing formalin-fixed, paraffin-embedded tissue. Only in rare cases did testing yield a genetic result that was discordant with the histopathologic diagnosis. We conclude that PCR-based testing is a useful adjunct for the diagnosis of malignant small round cell tumors, spindle cell tumors, and other miscellaneous neoplasms in routine surgical pathology practice.
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MESH Headings
- Base Sequence
- Humans
- Liposarcoma, Myxoid/diagnosis
- Liposarcoma, Myxoid/genetics
- Polymerase Chain Reaction
- Prospective Studies
- RNA, Neoplasm/analysis
- Rhabdomyosarcoma, Alveolar/diagnosis
- Rhabdomyosarcoma, Alveolar/genetics
- Rhabdomyosarcoma, Alveolar/pathology
- Sarcoma/diagnosis
- Sarcoma/genetics
- Sarcoma/pathology
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Small Cell/diagnosis
- Sarcoma, Small Cell/genetics
- Sarcoma, Small Cell/pathology
- Sarcoma, Synovial/diagnosis
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/pathology
- Soft Tissue Neoplasms/diagnosis
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Translocation, Genetic
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Affiliation(s)
- D Ashley Hill
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, MO, USA
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26
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27
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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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28
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Ishii N, Hiraga H, Sawamura Y, Shinohe Y, Nagashima K. Alternative EWS-FLI1 fusion gene and MIC2 expression in peripheral and central primitive neuroectodermal tumors. Neuropathology 2001; 21:40-4. [PMID: 11304041 DOI: 10.1046/j.1440-1789.2001.00367.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primitive neuroectodermal tumors (PNET) occur either in the central nervous system (CNS; central PNET, cPNET) or in the peripheral sites (peripheral PNET, pPNET). Recent molecular approaches have been defining a new concept of PNET, that is, the pPNET including Ewing's sarcoma (ES) which expresses MIC2 glycoprotein and shows the specific chimeric gene of EWS-FLI1. The expression of MIC2 and the genetic rearrangement of EWS-FLI1 are considered to be highly specific to the pPNET/ES. This study examined the expression of MIC2 and EWS-FLI1 gene by means of immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) on various small round cell tumors originating in the CNS or non-CNS organs. All peripheral PNET tested expressed MIC2 and were positive for EWS-FLI1 (11/11). In contrast, all cPNET and other blastic CNS tumors were negative for MIC2: medulloblastoma (0/3), cerebral PNET (0/2), spinal PNET (0/2), glioblastoma (0/2), retinoblastoma (0/3), and pineoblastoma (0/2). These MIC2-negative tumors were also negative for the chimeric gene product of EWS-FLI1. Interestingly, one PNET originating in the intracranial dura mater was positive for both MIC2 and EWS-FLI1 fusion gene. The results indicate that cPNET lacks any genetic or protein markers, except for a meningeal PNET which falls into the same phenotypic spectrum of pPNET.
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MESH Headings
- 12E7 Antigen
- Antigens, CD/analysis
- Antigens, CD/genetics
- Brain Neoplasms/chemistry
- Brain Neoplasms/pathology
- Brain Neoplasms/physiopathology
- Cell Adhesion Molecules/analysis
- Cell Adhesion Molecules/genetics
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Meningeal Neoplasms/chemistry
- Meningeal Neoplasms/pathology
- Meningeal Neoplasms/physiopathology
- Neuroectodermal Tumors, Primitive, Peripheral/chemistry
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/physiopathology
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Peripheral Nervous System Neoplasms/chemistry
- Peripheral Nervous System Neoplasms/pathology
- Peripheral Nervous System Neoplasms/physiopathology
- Phenotype
- Proto-Oncogene Protein c-fli-1
- RNA, Messenger/analysis
- RNA-Binding Protein EWS
- Transcription Factors/analysis
- Transcription Factors/genetics
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Affiliation(s)
- N Ishii
- Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan
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29
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Ishii N, Hiraga H, Sawamura Y, Shinohe Y, Nagashima K. Alternative
EWS‐FLI1
fusion gene and MIC2 expression in peripheral and central primitive neuroectodermal tumors. Neuropathology 2001. [DOI: 10.1111/j.1440-1789.2001.00367.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Hiroaki Hiraga
- Division of Orthopedics, Department of Clinical Research, National Sapporo Hospital, Sapporo and
| | | | | | - Kazuo Nagashima
- Laboratory of Molecular and Cellular Pathology, Hokkaido University School of Medicine and
- CREST, Japan Science and Technology, Japan
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30
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Taylor GB, Chan YF. Subcutaneous primitive neuroectodermal tumour in the abdominal wall of a child: long-term survival after local excision. Pathology 2001. [PMID: 11186429 DOI: 10.1080/pat.32.4.294.298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tumours of the peripheral primitive neuroectodermal tumour/Ewing's sarcoma (PNET/ES) family can rarely occur as primary lesions within the skin and subcutis. We present a case of subcutaneous PNET within the abdominal wall of a 33-month-old child. Histologically it was a small round cell tumour that marked strongly for CD99 and displayed ultrastructual evidence of neural differentiation. The tumour was completely excised, but due to an initial misdiagnosis no adjuvant therapy was given. Despite this, the patient is well without evidence of disease 10 years and 3 months after surgery. A review of similar cases reveals not all patients are as fortunate, suggesting combination therapy, including chemotherapy, is still the best treatment for these tumours, even when small and superficial. Our report therefore highlights the importance of recognising PNET/ES in the skin and subcutis so appropriate therapy can be administered.
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Affiliation(s)
- G B Taylor
- Histopathology Department, Starship Children's Hospital, Auckland, New Zealand.
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31
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Sandberg AA, Bridge JA. Updates on cytogenetics and molecular genetics of bone and soft tissue tumors: Ewing sarcoma and peripheral primitive neuroectodermal tumors. CANCER GENETICS AND CYTOGENETICS 2000; 123:1-26. [PMID: 11120329 DOI: 10.1016/s0165-4608(00)00295-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- A A Sandberg
- Department of DNA Diagnostics, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
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32
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Abstract
Many sarcomas are characterized by specific recurrent chromosomal translocations which provide powerful diagnostic tumor markers. Since 1992, the genes involved by almost all of these translocations have been cloned, inaugurating a new era in the study of sarcomas. At the biological level, these chromosomal translocations produce highly specific gene fusions, usually encoding aberrant chimeric transcription factors. Clinically, the correlation of these translocation-derived genetic markers and discrete histopathologic entities has been remarkable. Fusion gene detection has confirmed and refined the nosology of several sarcoma groups. The overall effect has been to strengthen certain pathological concepts rather than to revolutionize. The focus of this brief review is the recent impact that the cytogenetic and molecular detection of these translocations has had on sarcoma diagnosis and classification.
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Affiliation(s)
- M Ladanyi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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33
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Nicholson SA, McDermott MB, Swanson PE, Wick MR. CD99 and cytokeratin-20 in small-cell and basaloid tumors of the skin. Appl Immunohistochem Mol Morphol 2000; 8:37-41. [PMID: 10937047 DOI: 10.1097/00129039-200003000-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although it is classically a deep soft-tissue tumor of childhood, primitive neuroectodermal tumor (PNET) can occur at any age and may occasionally involve cutaneous sites. Merkel cell carcinoma (MCC) and basaloid neoplasms of cutaneous adnexa are the principal diagnostic alternatives to that tumor. The common expression of CD99 in PNET and cytokeratin-20 (CK20) in MCC suggests that these markers may be of value in this diagnostic setting, but they have not been rigorously examined in other small-cell and basaloid lesions of the skin. Accordingly, we evaluated CD99 and CK20 reactivity in formalin-fixed, paraffin-embedded sections of 30 MCC, five cutaneous metastases of pulmonary small-cell neuroendocrine carcinomas, 10 primary cutaneous adnexal carcinomas with basaloid features, 18 benign basaloid adnexal neoplasms of the skin (nine spiradenomas and nine cylindromas), and two cutaneous PNETs, using a standard immunohistologic technique and microwave-mediated epitope retrieval. Of the 30 MCC, 12 showed crisp membrane staining for CD99. Among the remaining tumors, only the two PNETs were positive for that marker. Although the majority of MCCs did not label for CD99, the pattern of reactivity in positive cases was indistinguishable from that observed in PNETs. Eighteen of 27 MCCs that were stained for CK20 were reactive for that protein, in contrast to metastatic small cell carcinomas, cutaneous PNETs, and appendageal skin tumors, which were uniformly negative for this marker. However, a subset of nine tumors, which were most consistent with MCC on clinical grounds, was CD99 positive and CK20 negative. Hence, reliance on CD99 alone as a diagnostic marker for PNET in this context cannot be recommended. Rather, careful assessment of the clinical presentation, together with extended immunophenotyping that includes other lineage markers and, when possible, cytogenetic analysis for characteristic chromosomal aberrations, remains the best means of separating MCC from PNET. Finally, the lack of CD99 reactivity in basaloid adnexal neoplasms of the skin suggests a utility in their differential diagnosis from cutaneous tumors with neuroendocrine or neuroectodermal differentiation.
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MESH Headings
- 12E7 Antigen
- Adenoma, Sweat Gland/immunology
- Adenoma, Sweat Gland/metabolism
- Adenoma, Sweat Gland/pathology
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Carcinoma, Adenoid Cystic/immunology
- Carcinoma, Adenoid Cystic/metabolism
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Merkel Cell/immunology
- Carcinoma, Merkel Cell/metabolism
- Carcinoma, Merkel Cell/pathology
- Cell Adhesion Molecules/metabolism
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Intermediate Filament Proteins/metabolism
- Keratin-20
- Neuroectodermal Tumors, Primitive/immunology
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/pathology
- Skin Neoplasms/immunology
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
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Affiliation(s)
- S A Nicholson
- Division of Surgical Pathology, Washington University Medical Center, St. Louis, Missouri, USA
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34
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Chow E, Merchant TE, Pappo A, Jenkins JJ, Shah AB, Kun LE. Cutaneous and subcutaneous Ewing’s sarcoma: an indolent disease. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(99)00391-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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35
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Abstract
This article briefly reviews many immunohistochemical stains that have been in use for years, emphasizing their diagnostic use and potential pitfalls. Several newer immunostains are described in a more comprehensive fashion, including brief summaries from recently published studies.
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Affiliation(s)
- A R Hudson
- Division of Dermatopathology, University of Arkansas for Medical Sciences, Little Rock, USA
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36
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Smith LM, Adams RH, Brothman AR, Vanderhooft SL, Coffin CM. Peripheral primitive neuroectodermal tumor presenting with diffuse cutaneous involvement and 7;22 translocation. MEDICAL AND PEDIATRIC ONCOLOGY 1998; 30:357-63. [PMID: 9589085 DOI: 10.1002/(sici)1096-911x(199806)30:6<357::aid-mpo10>3.0.co;2-f] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report an unusual case of peripheral primitive neuroectodermal tumor (pPNET) in an infant presenting with congenital cutaneous nodules and a t(7;22)(p21;q11.2). The biologic behavior of the tumor diverged over time from a slowly growing tumor with multiple cutaneous nodules to a more aggressive neoplasm characterized by pulmonary metastases and a soft tissue mass showing additional cytogenetic alterations.
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MESH Headings
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 7
- Humans
- Infant
- Male
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Skin/pathology
- Translocation, Genetic
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Affiliation(s)
- L M Smith
- Department of Radiation Oncology, University of Utah Health Sciences Center, Salt Lake City 84132, USA
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Hasegawa SL, Davison JM, Rutten A, Fletcher JA, Fletcher CD. Primary cutaneous Ewing's sarcoma: immunophenotypic and molecular cytogenetic evaluation of five cases. Am J Surg Pathol 1998; 22:310-8. [PMID: 9500772 DOI: 10.1097/00000478-199803000-00005] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cutaneous small blue cell tumors are relatively uncommon and include primary lesions of either adnexal or neuroendocrine differentiation, as well as metastatic disease. Extraosseous Ewing's sarcoma/malignant primitive neuroectodermal tumor (MPNET) rarely may occur as a primary, superficially based neoplasm in children and young adults. We describe a series of five cases of Ewing's sarcoma/malignant primitive neuroectodermal tumor occurring as a primary cutaneous malignancy supported diagnostically both by immunohistochemical stains and fluorescence in situ hybridization (FISH). All five cases occurred as a solitary dermal nodule and were located in the lower extremities (3 cases), the axilla (1 case), and the flank (1 case). Three of the cases were clinically polypoid. Four of the five patients were female, and age at presentation ranged form 8 to 50 years of age (median, 18 years). All five tumors consisted of nodular proliferations of monomorphous, small blue cells with round, vesicular nuclei, and scant to moderate cytoplasm that were uniformly immunoreactive for the CD99 cell surface glycoprotein in a characteristic membranous pattern. Fluorescence in situ hybridization analysis of paraffin-embedded tissue revealed that three of four tumors were positive for a chromosomal translocation involving the EWS locus at 22q12, seen in more than 90% of cases of Ewing's sarcoma/malignant primitive neuroectodermal tumor. One case was not analyzable. All five patients were treated using local excision, and two patients additionally received postoperative chemotherapy and radiotherapy. Clinical follow-up is available in three cases (median duration, 33 months) and to date none has shown evidence of either local recurrence or metastasis. Because similar cases reported in the literature have likewise had favorable clinical courses after excision, primary cutaneous Ewing's sarcoma/malignant primitive neuroectodermal tumor may represent a clinically favorable subset of this otherwise highly aggressive neoplasm.
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Affiliation(s)
- S L Hasegawa
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Batsakis JG, Mackay B, el-Naggar AK. Ewing's sarcoma and peripheral primitive neuroectodermal tumor: an interim report. Ann Otol Rhinol Laryngol 1996; 105:838-43. [PMID: 8865780 DOI: 10.1177/000348949610501014] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The primitive neuroectoderm and its progeny seemingly give rise to an ever-increasing number of clinicopathologic entities. Ewing's sarcoma and peripheral primitive neuroectodermal tumor have recently been united by relatively unique antigens expressed by the MIC-2 gene, commonly coexpressed neural markers, and cytogenetic and molecular genetic abnormalities. Because of these factors, the current thinking is that Ewing's sarcoma and the peripheral primitive neuroectodermal tumor are parts of a phenotypic spectrum. We present an "interim report" on this group of neoplasms, emphasizing their presentation in the head and neck.
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Affiliation(s)
- J G Batsakis
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, USA
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