Desmoplastic small round cell tumor of the abdomen and pelvis: clinicopathological characters of 12 cases

Intra-Abdominal Desmoplastic Small Round Cell Tumor: Current Treatment Options and Perspectives

Intra-abdominal desmoplastic small round cell tumor (IDSRCT) is a rare and highly malignant soft tissue neoplasm, which is characterized by rapid progression and poor prognosis. The mechanism underlying the development of this neoplasm remains elusive, but all cases are characterized by the chromosomal translocation t (11;22) (p13; q12), which results in a formation of EWSR1-WT1 gene fusion. The diagnosis of IDSRCT is often made with core-needle tissue biopsy specimens or laparoscopy or laparotomy. Immunohistochemical analyses have shown the co-expression of epithelial, neuronal, myogenic, and mesenchymal differentiation markers. FISH or reverse transcription polymerase chain reaction detecting EWS-WT1 fusion can be performed to assist in molecular confirmation. There is no standard of care for patients with IDSRCT currently, and majority of newly diagnosed patients received the aggressive therapy, which includes >90% resection of surgical debulking, high-dose alkylator-based chemotherapy, and radiotherapy. More recently, targeted therapy has been increasingly administered to recurrent IDSRCT patients and has been associated with improved survival in clinical conditions. Immunotherapy as a possible therapeutic strategy is being explored in patients with IDSRCT. In this review, we summarize currently available knowledge regarding the epidemiology, potential mechanisms, clinical manifestations, diagnosis, treatment, and prognosis of IDSRCT to assist oncologists in comprehensively recognizing and accurately treating this malignancy.

Irinotecan and vincristine for the treatment of refractory desmoplastic small round cell tumor in a developing country: a case report

Introduction

Desmoplastic small round cell tumor is an extremely rare and aggressive cancer that affects mainly adolescents and young adults. Despite multiple therapeutic strategies, most patients have resistant disease with very poor survival rates.

Case presentation

We present a case of a 10-year-old Caucasian boy with a desmoplastic small round cell tumor refractory to conventional treatment who exhibited a good response to alternative treatment. With use of irinotecan and vincristine in association with radiation therapy, a reduction of 96.9% of the dimensions of the target lesions compared with the initial image was observed.

Conclusion

This chemotherapy regimen, in association with radiation therapy, demonstrated efficacy for refractory desmoplastic small round cell tumor in our patient, and it is cost-effective.

Whole abdominopelvic radiotherapy in desmoplastic small round cell tumour of abdomen: a challenge for radiation oncologists

An adolescent patient diagnosed with disseminated abdominal desmoplastic small round cell tumour (DSRCT) was taken up for systemic chemotherapy, debulking surgery, stem cell transplant followed by whole abdominopelvic radiotherapy using intensity-modulated radiotherapy. Following this, the patient developed multiple episodes of small bowel obstruction, a known complication of abdominal surgery and radiotherapy. The patient expired due to the complications of bowel obstruction 13 months after the completion of radiotherapy. Though we managed to achieve a complete response at the disease sites with an aggressive therapeutic approach, the patient eventually succumbed to treatment-induced morbidity. Large prospective trials to define management guidelines taking into account quality of life issues may not be feasible for a rare and aggressive scenario such as DSRCT. Therefore, case reports and series reporting not just the treatment techniques and survival, but also the resultant toxicities, will make us vigilant when choosing the intensity of its treatment.

Clinical features and outcomes of 20 patients with abdominopelvic desmoplastic small round cell tumor

INTRODUCTION

Desmoplastic small round cell tumor (DSRCT) is a rare mesenchymal malignancy. We describe our experience with treating DSRCT at a large sarcoma referral center.

METHODS

A retrospective chart review was performed on DSRCT patients referred to our institution (1998-2014). Pathology specimens were reviewed to confirm the diagnosis. Clinical and imaging were extracted and summarized with descriptive statistics. Univariate analysis was performed to evaluate the association between patient, tumor, and treatment variables and overall survival (OS).

RESULTS

In this study cohort of 20 patients, median age at presentation was 29 y (range 18-43) and 90% were male. Fifty-five percent presented with metastasis. Patients underwent chemotherapy (n = 20), radiation therapy (n = 3), and cytoreductive surgery (CRS) (n = 5). Median OS was 22 m (interquartile range: 12-28 m). Five-year OS rate was 20%. Extra-abdominal metastasis was associated with a higher hazard ratio (HR) of mortality (HR: 3.1, 95% C.I. 1.0-9.4, p = 0.04), while CRS improved OS (HR: 0.1, 95% C.I. 0.03-0.7, p = 0.02).

CONCLUSIONS

Despite aggressive treatment, less than half of the patients were dead of DSRCT within 2 years of presentation. Although a select group of patients who underwent CRS had improved OS, novel treatments are urgently needed.

Complete response of giant desmoplastic small round cell tumor treated with chemoradiotherapy: A case report

Desmoplastic small round cell tumor (DSRCT) is a rare tumor that mainly affects adolescents, and typically involves the abdominal and pelvic peritoneum. The present study reports one case of giant DSRCT, treated with concurrent chemoradiotherapy, and reviews the available medical literature. A 38-year-old man presented with a 3-month history of pain in the left lower abdomen and nausea, associated with decreased appetite and weight loss. Computed tomography (CT) showed a 12.3×7.9 cm confluent solid mass in the lower abdomen and pelvic cavity. The patient underwent exploratory laparotomy and the final pathological diagnosis was DSRCT. Following laparotomy, the patient was treated with external beam radiotherapy to the whole abdomen and pelvis to a dose of 40 Gy plus a 20 Gy boost to the residual disease. The results indicated that synchronous chemotherapy with cyclophosphamide, adriamycin and cisplatin combined with radiotherapy significantly improved locoregional control of DSRCT and a complete response, as measured by CT assessment 2 months subsequent to radiotherapy. In conclusion, DSRCT is a rare malignancy requiring multidisciplinary treatment, including surgery, chemotherapy and radiotherapy. The results of the present study confirm that radiotherapy has a significant role in the treatment of advanced abdominal DSRCT and may contribute to durable remission.

DESMOPLASTIC SMALL ROUND BLUE CELL TUMOUR OF THE ABDOMEN - A CASE REPORT

Desmoplastic Small Round Cell Tumour (DSRCT) is an uncommon malignant type of Small Round Blue Cell tumours with less than 200 cases reported in literature. Notorious for its aggressiveness, its commonest site of affectation is the abdomen, with a predilection for peritoneal cavity and prone to spread to multiple organs. We report a case of a 26-year old male undergraduate who presented with a 6-month history of progressive abdominal swelling associated with abdominal pain, weight loss, and change in bowel habits. He was cachectic with dyspnoea, bilateral pitting pedal oedema, a grossly distended and a palpable huge firm mass measuring 20 x 15cm. Immunohistochemisttry confirmed a diagnosis of DSRCT. An abdominopelvic Computed Tomography (CT) scan showed extensive abdominal and pelvic disease with pulmonary and liver metastases. He could only tolerate one course of chemotherapy due to deteriorating renal function. It ran an aggressive course of 9 months from onset of symptoms to eventual demise of the patient.

CONCLUSION

Desmoplastic Small Round Blue Cell Tumour is an uncommon and fatal disease, with no significant improvement in survival despite aggressive multimodality therapy. A high index of suspicion and Immunohistochemistry for accurate diagnosis as well as prompt and effective treatment will improve outcome.

A Case of Desmoplastic Small Round Cell Tumor

Desmoplastic small round cell tumor is a rare, aggressive tumor primarily affecting young males. It is considered a childhood cancer, and is characterized by a unique chromosomal translocation which leads to failure to suppress tumor growth. It is classified as a soft tissue sarcoma, sharing some features with other small round cell tumors such as Ewing's Sarcoma and primitive neuroectodermal tumor. Typical imaging findings include multiple heterogeneous, lobular abdominal masses, which can grow very large. Often there is a dominant mass with additional peritoneal, omental, retroperitoneal and retrovesical masses. Prognosis is relatively poor with a 3 year survival rate of 50% in those treated aggressively with surgical resection, chemotherapy, and radiation therapy. The clinical presentation, imaging characteristics and pathology are discussed in regards to a recent case.

Results of multimodal treatment for desmoplastic small round cell tumor of the abdomen and pelvis

PURPOSE

Desmoplastic small round cell tumor (DSRCT) is a rare aggressive malignancy that occurs in a young population with a male predominance. We studied the clinical and pathological characteristics of DSRCT and investigated the effects of multimodal therapy including aggressive surgical resection, induction chemotherapy, and external beam radiotherapy.

METHODS

We retrospectively reviewed and analyzed our experience with 11 histologically proven cases of DSRCT between March 2004 and October 2014. The clinical information, histological, immunohistochemistry and survival data of the patients were collected.

RESULTS

The median age at diagnosis was 31.4 years (range, 14-64 years) and nine (82%) of the patients were males. The most common presenting complaint was abdominal pain (72.7%). Surgical resection was attempted in five patients and included macroscopic total resection in two patients and debulking in three patients. Six patients underwent biopsy only. Eleven patients received multiagent chemotherapy. Five patients (45.5%) received radiotherapy. The median survival of patients who underwent surgical resection was 34.5 months, whereas the patients who underwent biopsy alone was 24.5 months (P<0.05). The median survival was 40.8 months in radiotherapy group, and 19.2 months in non-radiotherapy group (P<0.05). The 3-year progression-free survival rate was 27.2%. The median survival was 29 months, and the median time to local failure was 8.8 months. Cox regression analysis showed surgery and radiotherapy were highly significant in prolonging patients survival.

CONCLUSION

Multimodal therapy consists of combination of surgical resection, chemotherapy and radiotherapy results in improved survival in patients with DSRCT. For unresectable DSRCT, we recommend radiotherapy combined with anthracycline-based chemotherapy.