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Tintila A, Doroftei B, Grab D, Simionescu G, Anton E, Maftei R, Ilea C, Anton C. Importance of studying primitive neuroectodermal tumors and extraosseous Ewings sarcoma of the vagina and vulva. Oncol Lett 2021; 21:171. [PMID: 33552288 DOI: 10.3892/ol.2021.12432] [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: 07/27/2020] [Accepted: 11/11/2020] [Indexed: 11/06/2022] Open
Abstract
Primitive neuroectodermal tumor (PNT) and Ewing's sarcoma are rare, round-cell tumors, characterized by the presence of the t(11; 22)(q24; q12) chromosomal translocation. A review of the literature revealed only 38 previously reported cases of vulvar PNT and Ewing's sarcoma and 15 vaginal PNT and Ewing's sarcoma. Although rare, these types of tumors should be taken into consideration when making a differential diagnosis for vulvar or vaginal tumors. The currently available data is limited, and therefore, case reports are essential for improving knowledge and management of these types of extremely rare tumors. However, further molecular and histopathological studies are essential for an improved understanding of these conditions and for an early, correct diagnosis. Although the gathered and presented data from the present review are limited, the literature demonstrates that the outcome of these types of cancer are more favorable compared with outcomes observed for carcinomas in more typical locations.
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Affiliation(s)
- Adeline Tintila
- Clinical Department, Spitalul Judetean Suceava, Suceava 720224, Romania
| | - Bogdan Doroftei
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania.,Clinical Department, Origyn Fertility Center, Iasi 700032, Romania
| | - Delia Grab
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania
| | - Gabriela Simionescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania.,Clinical Department, Origyn Fertility Center, Iasi 700032, Romania
| | - Emil Anton
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania
| | - Radu Maftei
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania
| | - Ciprian Ilea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania
| | - Carmen Anton
- Clinical Department, Sf. Spiridon Clinical Hospital, Iasi 700111, Romania.,Department of Gastroenterology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania
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2
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El Housheimi A, Khalil A, Khalifeh D, Berjawi G, Seoud M, Tabbarah A, Khaled C, Mahfouz R, Abdallah R. Primary vulvar Ewing sarcoma/peripheral primitive neuroectodermal tumor with pelvic lymph nodes metastasis: A case report and review of literature. J Obstet Gynaecol Res 2020; 46:2185-2192. [PMID: 32761741 DOI: 10.1111/jog.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/29/2020] [Accepted: 06/28/2020] [Indexed: 11/28/2022]
Abstract
Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumors (pPNET) are soft tissue tumors that generally affect the bones. Extraosseous ES/pPNET has been rarely reported. Our patient presented with a 6 × 4 cm right subcutaneous solid vulvar lesion causing pain and discomfort. Pathology and immunohistochemistry staining showed strong positivity for CD99 and vimentin, favoring the diagnosis of ES/pPNET. Magnetic resonance imaging showed a 6-cm lesion in the right vulvar region with enlarged bilateral inguinal and right iliac lymph nodes. Fluorescence in situ hybridization test for translocation t(11;22)(q24;q12) was positive, confirming the diagnosis. The patient received three cycles of neoadjuvant chemotherapy with vincristine, adriamycin, cyclophosphamide alternating with ifosfamide and etoposide with complete response. The patient underwent vulvar radical local excision. Residual tumor measured 1.6 cm with free margins. She received four additional cycles of adjuvant chemotherapy and 30 sessions radiotherapy. She is currently disease free after 37 months. No ES/pPNET cases with pelvic lymph nodes metastasis were ever reported.
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Affiliation(s)
- Alaa El Housheimi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dalia Khalifeh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Berjawi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abir Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Chirine Khaled
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Abdallah
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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3
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Xu QQ, Xing WW, Chen G, Dang YW, Luo YG, Chen P, Liang SW, Chen JB. Primitive neuroectodermal tumors of the abdominal wall and vulva in children: Report of two cases and review of the literature. World J Clin Cases 2019; 7:3671-3682. [PMID: 31750352 PMCID: PMC6854414 DOI: 10.12998/wjcc.v7.i21.3671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/25/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primitive neuroectodermal tumors are rare, highly malignant small round cell tumors belonging to the Ewing sarcoma family. The purpose of this article is to present clinical manifestation, histology, treatment, and prognosis of two primitive neuroectodermal tumors (PNETs) in extremely rare anatomic locations, the abdominal wall and vulva.
CASE SUMMARY Case 1 was a 66-month-old girl with lesions on the abdominal wall; tumor size was about 3.4 cm × 6.1 cm × 2 cm. The patient underwent radical resection of the tumor. After the operation, an alternating vincristine, doxorubicin, and cyclophosphamide/ifosfamide and etoposide (IE) regimen was given for eight cycles, and the patient survived for 66 mo without progression. Case 2 was a 40-month-old girl, with a vulvar lesion; tumor size was about 3.3 cm × 5 cm × 2.5 cm. The tumor was partially resected by surgery. The family left treatment after two cycles of vincristine, pirarubicin, and cyclophosphamide/IE chemotherapy, and the patient died at home six months after surgery.
CONCLUSION PNET is a rare, fast-growing, highly malignant tumor that requires histologic and molecular analyses for exact diagnosis, and multimodal treatment is required to achieve a good prognosis.
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Affiliation(s)
- Qiong-Qian Xu
- Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Wen-Wen Xing
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Gang Chen
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi-Wu Dang
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi-Ge Luo
- Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Peng Chen
- Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Song-Wu Liang
- Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jia-Bo Chen
- Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Tunitsky-Bitton E, Uy-Kroh MJS, Michener C, Tarr ME. Primary Ewing Sarcoma Presenting as a Vulvar Mass in an Adolescent: Case Report and Review of Literature. J Pediatr Adolesc Gynecol 2015. [PMID: 26211932 DOI: 10.1016/j.jpag.2015.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Extraosseous Ewing sarcoma (ES) tumors presenting in the genitourinary tract are highly uncommon. Few cases of primary vulvar and vaginal cases of ES have been published. CASE A 15-year-old adolescent presented with a bothersome 5-cm mass located on her left labium minorum. Following excision, a diagnosis of a primary ES was made. The patient was treated with multiagent chemotherapy and was doing well 20 months after treatment completion. SUMMARY AND CONCLUSION Based on the few available case reports and our reported case, it appears that extraosseous ES arising in superficial sites such as the vulva have better prognosis and should be treated with complete excision and multiagent chemotherapy.
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Affiliation(s)
- Elena Tunitsky-Bitton
- Cleveland Clinic, Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford, Connecticut.
| | - M Jean S Uy-Kroh
- Cleveland Clinic, Obstetrics and Gynecology, Division of Benign Gynecology, Hartford, Connecticut
| | - Chad Michener
- Cleveland Clinic, Obstetrics and Gynecology, Division of Gynecologic Oncology, Hartford, Connecticut
| | - Megan E Tarr
- Cleveland Clinic, Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Hartford, Connecticut
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5
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Che SM, Cao PL, Chen HW, Liu Z, Meng D. Primary Ewing's sarcoma of vulva: a case report and a review of the literature. J Obstet Gynaecol Res 2012; 39:746-9. [PMID: 23106919 DOI: 10.1111/j.1447-0756.2012.02019.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/24/2012] [Indexed: 12/15/2022]
Abstract
Ewing sarcomas/peripheral primitive neuroectodermal tumors (ES/pPNET) are extremely rare in the vulva. A review of the literature reveals only 14 previously reported possible cases. Here we reported a case of primary extraskeletal Ewing's sarcoma (EES) of the vulva in a 37-year-old woman. Characteristic histologic features of ES/pPNET were present in this case, including a monomorphic population of small round blue cells with cytoplasmic glycogen confirmed by periodic acid-Schiff, membrane staining with CD99 and nuclear staining with FLI-1. After surgery, the patient was found to have pulmonary metastasis and then received six cycles of polychemotherapy. She is still alive with stable disease after 1 year of follow up. Our findings underline the crucial role of immunohistochemical techniques in the differential diagnosis of small round cell tumors in these unusual locations. We also give a summary about the clinical and pathological features of the primary ES/pPNET in the vulva reported previously in the literature.
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Affiliation(s)
- Shao-Min Che
- Department of Radiation Oncology, First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710061, China.
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Yang J, Guo Q, Yang Y, Zhang J, Lang J, Shi H. Primary vulvar Ewing sarcoma/primitive neuroectodermal tumor: a report of one case and review of the literature. J Pediatr Adolesc Gynecol 2012; 25:e93-7. [PMID: 22840944 DOI: 10.1016/j.jpag.2012.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/18/2012] [Accepted: 03/29/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ewing sarcoma/primitive neuroectodermal tumors (ES/PNET) are aggressive malignancies characterized by translocation involving the EWS gene. Primary extraskeletal ES/PNET rarely affects the female genital tract. CASE We report the case of a 20-year-old female, who presented with a rapidly growing painful mass arising from the left labium majus for six months. Multiple lesions in bones and nodules in lungs were considered metastasis. The diagnosis was established by immunohistochemical stain and reverse transcriptase polymerase chain reaction analysis. The patient ceased treatment and died of respiratory failure one month after discharge. CONCLUSION Vulvar ES/PNET mainly affects adolescent females. ES/PNET should be considered in the differential diagnosis of tumors involving the lower gynecologic tract in adolescent female.
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Affiliation(s)
- Jie Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Orr WS, Shannon Orr W, Denbo JW, Billups CA, Wu J, Navid F, Rao BN, Davidoff AM, Krasin MJ. Analysis of prognostic factors in extraosseous Ewing sarcoma family of tumors: review of St. Jude Children's Research Hospital experience. Ann Surg Oncol 2012; 19:3816-22. [PMID: 22739653 DOI: 10.1245/s10434-012-2458-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Advances in the treatment of Ewing sarcoma family of tumors (ESFT) are the result of improvements in systemic and local therapies. Clinical data of extraosseous ESFT are scarce. METHODS A retrospective analysis of all patients with extraosseous ESFT treated at St. Jude Children's Research Hospital (SJCRH) from June 1982 to August 2009. RESULTS Forty-six patients with extraosseous ESFT were identified. The mean age at diagnosis was 13.8 years. The majority of patients were male and white. The most common site of primary tumor was the trunk. Twelve patients had subcutaneous tumors. The median tumor size was 8 cm. Six patients (13 %) had metastatic disease at diagnosis. A total of 59 % of patients were alive at the time of analysis, with a median follow-up from diagnosis of 15.3 years. Fifteen-year estimates of survival and event-free survival (EFS) for all patients were 53.3 ± 9.4 and 50 ± 9.1 %, respectively. Fifteen-year estimates of survival and EFS with localized disease were 61.4 ± 9.8 and 57.6 ± 9.7 %, respectively. Stage and subcutaneous ESFT were significant predictors of outcome. There was no significant difference in patient's demographics and tumor characteristics between patients with skeletal ESFT and extraosseous Ewing sarcoma. The outcome for patients with localized extraosseous Ewing sarcoma was similar to that reported for all localized ESFT patients treated at SJCRH. CONCLUSIONS The outcome for localized patients treated with extraosseous ESFT was similar to that reported for all ESFT patients treated on protocols at SJCRH. Patients with subcutaneous ESFT had a favorable prognosis when compared to their counterparts.
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Affiliation(s)
| | - W Shannon Orr
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Primary metastasized extraskeletal Ewing sarcoma of the vulva: report of a case and review of the literature. Arch Gynecol Obstet 2011; 285:785-9. [PMID: 21805144 DOI: 10.1007/s00404-011-2011-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 07/08/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET) are closely related malignant neoplasms, usually affecting the skeletal system. Extraosseous ES/PNETs are uncommon, with occasional reports of tumors affecting the genitourinary tract. Only few cases of primary vulvar Ewing's sarcoma/PNET have previously been reported. METHODS We present a patient with primary vulvar Ewing's sarcoma with pulmonary metastasis who presented at the Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck. RESULTS The present report is the third case of a primary vulvar Ewing's sarcoma and the first constellation with pulmonary metastasis at diagnosis in the current literature. We present the diagnostic and therapeutic management including surgery, chemotherapy and radiation. CONCLUSION The treatment of the Ewing's sarcomas and PNETs requires a multidisciplinary systemic approach. Despite its rarity, the differential diagnosis of vulvar sarcoma must be considered in young women.
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Abstract
BACKGROUND Peripheral neuroectodermal tumors arising from vulva are extremely rare; only 12 cases have been reported so far. These tumors belong to the Ewing sarcoma family of tumors. They occur in bones and variety of soft tissues of chest wall, pelvis, paravertebral region, and lower extremities. Being aggressive tumors, they have poor prognosis. CASE We report a case of a 20-year-old woman who presented with a 20 x 15 x 10-cm pedunculated mass arising from the right labium majus. Judicious use of a panel of markers led to diagnosis of peripheral neuroectodermal tumor. The patient died of metastatic disease. CONCLUSIONS Judicious use of a panel of markers and a molecular test, if necessary, helps in confirming the diagnosis. Surgery followed by chemotherapy with or without radiation is the treatment of choice.
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10
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Cetiner H, Kir G, Gelmann EP, Ozdemirli M. Primary vulvar Ewing sarcoma/primitive neuroectodermal tumor: a report of 2 cases and review of the literature. Int J Gynecol Cancer 2009; 19:1131-6. [PMID: 19820381 DOI: 10.1111/igc.0b013e3181acae33] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) family of tumor is a very aggressive malignant round cell tumor characterized by translocations involving EWS-FLI1 genes. They are increasingly recognized in extraosseous sites as a result of improvements in diagnostic tools. In this paper, we report 2 additional cases arising in vulva of young adults who have been treated aggressively and have survived fore more than 7 and 4 years successively. Histologic examination showed small round (blue) cell morphology in both cases. The tumor cells contained glycogen and were positive for CD99 and vimentin and negative for keratins, lymphoid markers, S-100, synaptophysin, chromogranin, and desmin. Reverse transcriptase polymerase chain reaction analysis from paraffin-embedded tissue revealed EWS-FLI1 fusion product in 1 case. Collectively, 13 cases of vulvar ES/PNET have been reported in the literature. Only 8 cases have detailed follow-up information with an average follow-up data of 28 months. Ewing sarcoma/PNET should be considered in the differential diagnosis of any undifferentiated tumors involving the lower gynecologic tract and all axillary tests including molecular tests should be performed for correct diagnosis because prolonged survival is possible for this dreadful disease after complete surgical resection, followed by adjuvant therapy.
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Affiliation(s)
- Handan Cetiner
- Department of Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, 3900 Reservoir Road NW, Washington, DC 20007, USA
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11
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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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12
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Miller ME, Emerson L, Clayton F, Bentz BG, Data RE, Salzman KL, Smith LM, Yu MK. Extraosseous Ewing's Sarcoma. J Clin Oncol 2007; 25:4845-8. [DOI: 10.1200/jco.2007.13.0930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mark E. Miller
- Department of Pathology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Lyska Emerson
- Department of Pathology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Frederic Clayton
- Department of Pathology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Brandon G. Bentz
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Karen L. Salzman
- Department of Radiology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Lynn M. Smith
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Margaret K. Yu
- Department of Internal Medicine, Division of Hematology and Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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13
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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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