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Almohaisen GA, Alhuwairini SF, Aljrayed MA, Alenezi MM, Alsaab F. Extraskeletal Ewing's sarcoma of the head and neck region in pediatric patients: A case report and literature review. Int J Surg Case Rep 2023; 106:108142. [PMID: 37141776 PMCID: PMC10176168 DOI: 10.1016/j.ijscr.2023.108142] [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: 12/15/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Extraskeletal Ewing's sarcoma (EES) is a collection of malignant cells that appear small and round and occur mostly in pediatrics and adolescence. Head and neck EES tumors are considered rare and require multidisciplinary care to achieve ideal results in management. CASE PRESENTATION A 14-year-old boy who complained of a mass protruding from the back of his neck which gradually increased in size in the last few months prior to the diagnosis. He was referred to a pediatric otolaryngology clinic with a one-year history of chronic painless nape swelling. Ultrasound prior to the referral was done and the findings revealed a well-defined rounded hypoechoic lesion with internal vascularity. MRI was done and the impression was a large subcutaneous, well defined enhancing soft tissue lesion which raised the suspicion of sarcoma. The multidisciplinary team decision was to go for complete resection with a free margin followed by chemoradiation postoperatively. No evidence of recurrence was detected throughout the follow-up. CLINICAL DISCUSSION The literature review included ages of the pediatric group from 4 months up to 18-year-old. Clinical features are highly dependable on the size and site of the lesion. Complete resection of the tumor plays an important role in the local control and prognosis. CONCLUSION We present a rare case of extraskeletal Ewing's sarcoma of the nape. Computed tomography and magnetic resonance imaging are frequently used as imaging modalities in evaluating and diagnosing EES. Management commonly includes surgery with adjuvant chemotherapy to decrease recurrence and prolong the survival rate.
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Affiliation(s)
- Ghadi A Almohaisen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Sara F Alhuwairini
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maha A Aljrayed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mazyad M Alenezi
- Department of Otolaryngology Head and Neck Surgery, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Fahad Alsaab
- Department of Pediatric Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia; Department of Pediatric Surgery, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Pediatric Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Kumar P, Panda SS, Singh S, Sarin YK. Congenital Cutaneous Peripheral Primitive Neuroectodermal Tumor (pPNET) of Scalp: Youngest Case So Far. J Indian Assoc Pediatr Surg 2021; 26:60-62. [PMID: 33953517 PMCID: PMC8074827 DOI: 10.4103/jiaps.jiaps_68_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 11/04/2022] Open
Abstract
Congenital cutaneous peripheral primitive neuroectodermal tumor (pPNET) is very rare and also very rarely located in scalp. Only two cases of PNET as primary tumor in scalp are reported so far in the literature. Non mutilating surgical excision, combined with chemotherapy and radiotherapy are used in treating these rare tumors. We present the youngest case report of PNET of scalp in 10-month-old girl who was managed by surgical excision with good cosmetic outcome and disease-free 20 months post-operative period.
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Affiliation(s)
- Parveen Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Sarika Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Yogesh Kumar Sarin
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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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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Kourda M, Chatti S, Sfia M, Kraiem W, Ben Brahim E. Sarcome d’Ewing à localisation cutanée primitive. Ann Dermatol Venereol 2005; 132:986-9. [PMID: 16446642 DOI: 10.1016/s0151-9638(05)79562-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cutaneous extraskeletal Ewing's sarcoma is rare, being seen principally in children. We report a case of cutaneous sarcoma in the sole of the foot in a child. CASE REPORT A 9-year-old child with no medical history of note was presenting a skin tumor for 3 months on the heel of the right foot. This tumor was burgeoning and painful and measured 3.5 cm in diameter; it was ulcerative at the surface and covered with a crust. Histological and immunohistochemical examinations confirmed the diagnosis of Ewing's sarcoma. Staging examinations proved negative and the patient underwent polychemotherapy, resulting in complete regression of the tumor. COMMENTS Until 1998, 37 cases of cutaneous and subcutaneous Ewing's sarcoma were reported, being seen in 21 girls and 16 boys. Mean age at diagnosis was 15 years and mean tumor size was 3 cm (range: 1 to 12 cm). The tumors were observed throughout the body, being seen in the sole of the foot in 2 cases. Confirmation of the diagnosis was made by histological examination (malignant proliferation of small round cells in the dermis), immunohistochemical examination (CD99+) and cytogenetic analysis (translocation between chromosomes 22 and 11). The prognosis for cutaneous Ewing's sarcoma appears more favorable than that of Ewing's sarcoma in bone. Of the 37 patients treated, 7 had metastases and 2 presented relapse. Treatment for cutaneous Ewing's sarcoma, though not codified, consists of polychemotherapy associated with surgery and/or radiotherapy.
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Affiliation(s)
- M Kourda
- Service de Dermatologie, Hôpital de Nabeul, Tunisie.
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Hadfield MG, Quezado MM, Williams RL, Luo VY. Ewing's family of tumors involving structures related to the central nervous system: a review. Pediatr Dev Pathol 2000; 3:203-10. [PMID: 10742406 DOI: 10.1007/s100249910026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This review consolidates information gleaned from several case reports and larger series on Ewing's sarcoma family of tumors (EFT) involving structures related to and found in the central nervous system (CNS). These tumors involve the skull, the spinal column, adjacent soft tissues, the meninges, and the brain. We have separated the cases by skull region and spinal column level, and we discuss the attendant differences in prognosis following treatment by neurosurgery, radiation, and chemotherapy. Light and electron microscopic features can be used to differentiate EFT from other small round blue cell tumors that involve the CNS (central primitive neuroectodermal tumor, lymphoma, etc.). Recent molecular and genetic findings in EFT provide new diagnostic methods. We conclude that EFT involving the CNS and adjacent structures is not so rare as previously stated and that the prognosis is more favorable, as a rule, than for the more common examples arising in the long bones and pelvis.
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Affiliation(s)
- M G Hadfield
- Division of Neuropathology, Medical College of Virginia Campus/Virginia Commonwealth University, Richmond, VA 23298, USA
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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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Balakrishnan R, Khairullah QT, Giraldo A, Provenzano R. Extraskeletal Ewing's sarcoma in a kidney transplant patient. Am J Kidney Dis 1999; 33:1164-7. [PMID: 10352208 DOI: 10.1016/s0272-6386(99)70157-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Organ transplant recipients are prone to develop a variety of malignancies, most of which are encountered uncommonly in the general population. Approximately 5% to 7% of these malignancies are sarcomas, of which most are Kaposi's sarcomas. Ewing's sarcoma is an extremely uncommon tumor in organ transplant recipients, and only one case of skeletal Ewing's sarcoma has been reported in the transplant literature. We present a case of extraskeletal Ewing's sarcoma (EES) in a renal transplant patient.
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Affiliation(s)
- R Balakrishnan
- Division of Nephrology, St John Hospital and Medical Center, Detroit, MI, 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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Abstract
This is the first reported case of congenital extraskeletal Ewing's sarcoma (EES) in the head and neck region. The tumor arose from the medial aspect of the right lower eyelid and rapidly increased in size despite surgery and chemotherapy. Accurate histologic diagnosis is emphasized, and the differential diagnosis, pathology, and treatment are discussed.
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Affiliation(s)
- T C Lim
- Department of Surgery, National University Hospital, Singapore
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Abstract
The case of a 7-year-old boy with a spinal epidural extraosseous Ewing's sarcoma (EES) is presented. He is in complete remission without neurologic deficit 40 months after diagnosis. Another 15 cases were found in the literature and are discussed together with this patient. Twelve of them were male patients. The mean age of the patients was 17.5 years (range, 4 to 47). Symptoms included back pain and/or radicular pain (100%), paresis of one or both legs (83%), sensory disturbances, and bladder and bowel dysfunction. The mean diagnostic delay was 5.8 months. Each patient underwent laminectomy; complete resection of the tumor was impossible in more than 50% of the cases. Most patients received radiation therapy and/or chemotherapy. Four patients suffered from local recurrence, eight from metastases. Ten (63%) patients died, 1 to 48 months (mean, 16) after diagnosis. The differential diagnosis is discussed, including disk herniation and several benign and malignant tumors.
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Affiliation(s)
- G J Kaspers
- Department of Pediatrics, Free University Hospital, Amsterdam, The Netherlands
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