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Sharma AE, Wepy CB, Chapel DB, Maccio L, Irshaid L, Al-Ibraheemi A, Dickson BC, Nucci MR, Crum CP, Fletcher CDM, Kolin DL. Ewing Sarcoma of the Female Genital Tract: Clinicopathologic Analysis of 21 Cases With an Emphasis on the Differential Diagnosis of Gynecologic Round Cell, Spindle, and Epithelioid Neoplasms. Am J Surg Pathol 2024; 48:972-984. [PMID: 38708674 DOI: 10.1097/pas.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Ewing sarcoma is an uncommon neoplasm considered in the differential diagnosis of tumors with "small round cell" morphology, but its occurrence in the gynecologic tract has only been sporadically documented. Herein, we describe the largest cohort of Ewing sarcoma localized to the female genital tract to date, and emphasize their clinicopathologic resemblance to more common gynecologic neoplasms. Ewing sarcoma (n=21) was retrospectively identified from 5 institutions. The average patient age was 35 (range 6-61) years. Tumor sites included uterus (n=8), cervix (n=4), vulva (n=5), vagina (n=1), broad ligament (n=1), inguinal area (n=1), and pelvis (n=1). Nine of 18 cases in which slides were available for review demonstrated only classic round cell morphology, with the remainder showing a variable combination and prominence of variant ovoid/spindle or epithelioid appearance. Tumors showed diffuse membranous reactivity for CD99 (20/20) and were positive for NKX2.2 (8/8, diffuse) and cyclin D1 (7/7, of which 3/7 were patchy/multifocal and 4/7 were diffuse). They were negative for ER (0/6) and CD10 (0/6). Three cases were initially diagnosed as endometrial stromal sarcomas. EWSR1 rearrangement was confirmed in 20/21 by fluorescence in situ hybridization (n=15) and/or sequencing (n=8). Of the eight tumors that underwent sequencing, 6 harbored FLI1 , 1 ERG, and 1 FEV as the fusion partner. Of 11 patients with available follow-up, 5 died of disease, 1 developed lung metastases and 5 are alive with no evidence of disease. Ewing sarcoma of the gynecologic tract is a rare, aggressive entity that shares some morphologic and immunohistochemical features with other more common gynecologic neoplasms. In addition to the typical round cell appearance, variant spindled/ovoid to epithelioid morphology may also be observed and should prompt consideration of this entity with appropriate immunohistochemical and/or molecular studies.
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MESH Headings
- Humans
- Female
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/diagnosis
- Sarcoma, Ewing/chemistry
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/genetics
- Genital Neoplasms, Female/diagnosis
- Adult
- Diagnosis, Differential
- Adolescent
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/analysis
- Young Adult
- Middle Aged
- Child
- Retrospective Studies
- RNA-Binding Protein EWS/genetics
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Homeobox Protein Nkx-2.2
- Transcription Factors/genetics
- Homeodomain Proteins/genetics
- Predictive Value of Tests
- Gene Rearrangement
- 12E7 Antigen/metabolism
- Epithelioid Cells/pathology
- Epithelioid Cells/chemistry
- Nuclear Proteins
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Affiliation(s)
- Aarti E Sharma
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Cindy B Wepy
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David B Chapel
- Department of Pathology, University of Michigan Hospital, Ann Arbor, MI
| | - Livia Maccio
- Unit of Surgical Pathology, Santa Chiara Hospital, Trento, Italy
| | - Lina Irshaid
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Marisa R Nucci
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - David L Kolin
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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2
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Khaled C, D'Haene N, Noël JC. "Uterine-type" Extra-uterine High-grade Sarcoma of the Rectovaginal Septum: Case Report and Review of Literature. Int J Gynecol Pathol 2024:00004347-990000000-00190. [PMID: 39230419 DOI: 10.1097/pgp.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
The rectovaginal septum is an unusual location for neoplastic processes. The majority of these are extensions of tumors of the rectum or vagina. Masses arising primarily from the rectovaginal fascia are rare. Most primary rectovaginal malignant neoplasms are carcinomas that arise in the setting of endometriosis. Sarcomas in this location are exceedingly rare, with only few cases reported in the literature. We report a case of a 44-year-old lady who developed a high-grade sarcoma in the rectovaginal septum in the setting of endometriosis. We also discussed the differential diagnosis of this lady's challenging and unique lesion, which is most probably an extra-uterine "uterine-type" high-grade sarcoma that shows overlapping features of several entities. Moreover, we performed a literature review of sarcomas in this rare location. Given the fact that the rectovaginal septum is a common location for endometriosis, in the case of a rectovaginal neoplasm, a thorough sampling and a careful search for endometriotic lesions are important, as they may be a clue for the diagnosis. Although rare, sarcomas should always be considered in the differential diagnosis of rectovaginal neoplasms.
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Affiliation(s)
- Chirine Khaled
- Department of Pathology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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3
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Addison S, Ganzon R, Kim HG, Iwenofu H, Tinoco G. An unusual presentation of extraskeletal vaginal Ewing sarcoma: A case report. Case Rep Womens Health 2023; 38:e00523. [PMID: 37440766 PMCID: PMC10334311 DOI: 10.1016/j.crwh.2023.e00523] [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: 06/14/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Ewing sarcoma (ES) is a rare, aggressive malignancy that typically arises from bone and is seen more in adolescents and young adults. In contrast, extraskeletal Ewing sarcoma (EES) is more prevalent in adults and women [1,2]. There is no standard treatment for extraskeletal tumors, especially those in sensitive areas, such as the vagina, where resection may cause a large cosmetic or functional deformity. This case features a woman in her 20s who presented with painless vaginal bleeding and was found to have a 4 × 5 × 4-mm EES of the posterior vaginal wall. The presentation raised both reproductive and functional concerns, as the patient was young, sexually active and of childbearing age. The patient underwent treatment with radiation therapy and chemotherapy every 3 weeks. Given the lack of guidance and proclivity of EES to metastasize, it is paramount to proceed with standard-of-care treatment even if it is small and there is a lack of metastatic disease. For women with vaginal EES who are of childbearing age, brachytherapy rather than surgical resection may be a more favorable option when considering the location and the potential impact of vaginectomy.
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Affiliation(s)
- Sarah Addison
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rebecca Ganzon
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Han Gil Kim
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Hans Iwenofu
- Department of Radiology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Gabriel Tinoco
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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4
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Chen HJ, Chao HM, Chang JL, Chen YL, Yen CC. Primary Ewing's sarcoma of the jejunum presenting as sepsis. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_101_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Fujimoto T, Tanuma F, Otsuka N, Kataoka S. Laparoscopic posterior pelvic exenteration for primary adenocarcinoma of the rectovaginal septum without associated endometriosis: A case report. Mol Clin Oncol 2019; 10:92-96. [PMID: 30680193 DOI: 10.3892/mco.2018.1751] [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: 06/13/2018] [Accepted: 10/23/2018] [Indexed: 11/06/2022] Open
Abstract
The present report describes a case of laparoscopic posterior pelvic exenteration of a primary adenocarcinoma of the rectovaginal septum (PARS) without associated endometriosis. A 49-year-old woman was admitted to hospital for rectal bleeding. Imaging studies showed a 7-cm solid tumor located in the rectovaginal septum, presenting with invasion to the posterior aspect of the uterine cervix and the anterior rectal wall. The patient received laparoscopic posterior exenteration and rectosigmoid anastomosis followed by chemotherapy. There were no intra- or post-operative complications. Histopathological examination of the neoplastic tissue revealed moderate to severe cytological atypia with bizarre multinucleated cells and prominent mitotic figures. Histopathologically, R0 resection was achieved. No endometriotic lesions were confirmed in the primary tumor or other removed tissues. Immunohistochemistry showed positive staining for cytokeratin (CK)7, cancer antigen 125, vimentin, estrogen receptor and p53, but negative staining for CK20, progesterone receptor, p40 and thyroid transcription factor 1. Based on these findings and on the location of the tumor, the neoplasm was diagnosed as PARS without associated endometriosis, which may have arisen from metaplasia of the embryological Müllerian-duct remnants.
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Affiliation(s)
- Toshio Fujimoto
- Department of Obstetrics and Gynecology, Tomakomai City Hospital, Tomakomai, Hokkaido 053-8567, Japan
| | - Fumie Tanuma
- Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Hokkaido 040-8585, Japan
| | - Noriyuki Otsuka
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Soromon Kataoka
- Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Hokkaido 040-8585, Japan
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6
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Affiliation(s)
- Debra S. Heller
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
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7
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Ishida M, Iwai M, Yoshida K, Kagotani A, Okabe H. Extraosseous Ewing's sarcoma arising in the perineal region (Rectovaginal Septum). Diagn Cytopathol 2013; 42:1002-5. [DOI: 10.1002/dc.23040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/18/2013] [Accepted: 08/27/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Mitsuaki Ishida
- Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
- Division of Diagnostic Pathology; Shiga University of Medical Science; Shiga Japan
| | - Muneo Iwai
- Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
- Division of Diagnostic Pathology; Shiga University of Medical Science; Shiga Japan
| | - Keiko Yoshida
- Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
- Division of Diagnostic Pathology; Shiga University of Medical Science; Shiga Japan
| | - Akiko Kagotani
- Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
- Division of Diagnostic Pathology; Shiga University of Medical Science; Shiga Japan
| | - Hidetoshi Okabe
- Department of Clinical Laboratory Medicine; Shiga University of Medical Science; Shiga Japan
- Division of Diagnostic Pathology; Shiga University of Medical Science; Shiga Japan
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8
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Abstract
Ewing sarcoma, a highly malignant neoplasm of the bone, usually occurs during childhood. About 15% are extraosseous. The Ewing family of tumors (EFTs) are extremely rare in the vagina. A 40-year literature review from 1970 to 2010 revealed only nine cases. A 32-year-old woman presented with a painless vaginal mass. A wide excision was performed. Histopathology, immunohistochemistry and molecular studies confirmed extraosseous vaginal Ewing sarcoma. Despite aggressive chemotherapy with a good initial response, she developed local recurrence and metastasis to the spine and pelvis and succumbed 22 months later. A previous infiltrating ductal breast cancer, treated and in remission complicated the picture. We present the tenth case of vaginal Ewing sarcoma and the fourth to be confirmed by molecular studies. We stress the importance of molecular techniques in definitely diagnosing EFTs, especially those arising at unusual sites, particularly in the context of a previous diagnosis of breast cancer.
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Affiliation(s)
- Lovina Machado
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman.
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9
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Dasari P, Verma SK. Extraosseous Ewing's Sarcoma in the Uterovesical Fold Presenting as a Uterine Fibroid. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2010.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Papa Dasari
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
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10
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Turkyilmaz Z, Sonmez K, Karabulut R, Sen MC, Poyraz A, Oguz A, Basaklar AC. Extraskeletal Ewing sarcoma of the mesocolon in a child. J Pediatr Surg 2012; 47:E1-3. [PMID: 22974628 DOI: 10.1016/j.jpedsurg.2012.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 12/01/2022]
Abstract
Ewing sarcoma (ES) is a malignant neoplasm usually affecting the skeletal system. Extraskeletal ES is a rare tumor. To date, only 1 case of primary mesocolon ES has been previously reported in an adult. Herein, we present the first case of ES in the mesocolon in a child.
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Affiliation(s)
- Zafer Turkyilmaz
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, 06500 Ankara, Turkey.
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11
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Abstract
Ewing sarcoma (ES) and primitive neuroectodermal tumor (PNET) are round-cell sarcomas with varying degrees of neuroectodermal differentiation; they are considered members of the same family of tumors based on their common genetic profile. ES/PNET are very infrequent in the female genital tract, the vagina being the rarest gynecological location, with 7 cases reported to date. The authors present a case of vaginal ES/PNET with typical morphological and immunohistochemical features. EWS gene rearrangement was demonstrated by fluorescent in situ hybridization analysis. Of the 7 previously reported cases, only 2 have molecular confirmation. The age at presentation for vaginal ES/PNET is slightly higher than that for these neoplasms in bone and soft tissues, with only 1 reported patient younger than 30 years. The outcome seems to be similar to that of other superficially sited ES/PNET and more favorable than for those observed in the more typical locations. However, the currently available data are limited, and therefore, a larger number of cases is necessary to draw any firm conclusions.
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Affiliation(s)
| | - Enrique de Álava
- University of Salamanca and Hospital Universitario de Salamanca, Salamanca, Spain
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12
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Primary Ewing's sarcoma/primitive neuroectodermal tumor of the vagina in a 54-year-old woman: a case report. Arch Gynecol Obstet 2011; 285:1031-3. [PMID: 21986715 DOI: 10.1007/s00404-011-2084-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ewing's sarcoma (ES)/primitive neuroectodermal tumor (PNET) of the genital tract of women is uncommon. Presentation in vagina is exceedingly rare. CASE A 54-year-old Chinese woman presented with complaints of vaginal bleeding with fragmented bits occasionally. Physical examination revealed two nodules about 4 cm × 3 cm in the vagina. The immunohistochemical stains revealed a rare presentation of a primitive neuroectodermal tumor. The patient was treated with whole-pelvis external beam radiation, vaginal cylinder intracavitary brachytherapy, intracavitary afterloading radiotherapy and bilateral groin area radiotherapy. She died of clinical recurrence after 18 months of treatment. CONCLUSION This is the oldest but virgin case, treated with radiation completely, of primitive neuroectodermal tumor located in the vagina reported in the literature.
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13
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Rekhi B, Qureshi S, Basak R, Desai SB, Medhi S, Kurkure P, Menon S, Maheshwari A, Jambhekar NA. Primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old woman: a case report. J Med Case Rep 2010; 4:88. [PMID: 20233457 PMCID: PMC2848680 DOI: 10.1186/1752-1947-4-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 03/17/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Primary Ewing's sarcoma or primitive neuroectodermal tumor of the genital tract of women is uncommon. Rarer still is its occurrence in the vagina, with only five cases described so far. Out of these, only one case was confirmed using molecular analysis. Case presentation We present an extremely rare case of Ewing's sarcoma or primitive neuroectodermal tumor in a 17-year-old Indian girl. She presented with a vaginal mass that was initially diagnosed as a malignant round cell tumor. Immunohistochemistry showed diffuse positivity for vimentin, membranous positivity for MIC2, and positivity for BCL2 and FLI-1. On the other hand, she was negative for cytokeratin, epithelial membrane antigen, desmin, Myo D-1, myogenin and smooth muscle actin. A diagnosis of primitive neuroectodermal tumor was thus offered. Furthermore, a molecular analysis of our patient using reverse transcription-polymerase chain reaction technique showed positivity for t(11; 22) (q24; q12) (EWSR1-FLI1), thus confirming the diagnosis of a Ewing's sarcoma/primitive neuroectodermal tumor. Our patient was offered chemotherapy on Institutional protocol EFT 2001. Conclusion This is a rare case of primary vaginal Ewing's sarcoma or primitive neuroectodermal tumor, which was confirmed with molecular analysis, in the youngest patient known so far. This study reinforces the value of integrating morphological features with membranous MIC2 positivity, along with application of molecular techniques in objective identification of an Ewing's sarcoma or primitive neuroectodermal tumor at uncommon sites.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Dr EB Road, Parel, Mumbai, 400012, India.
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14
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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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15
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Retroperitoneal primitive neuroectodermal tumour (PNET). A case report and review of the literature. Rep Pract Oncol Radiother 2009. [DOI: 10.1016/j.rpor.2009.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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16
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Extraskeletal neuroectodermal tumour of the vagina: a single case report and review. Arch Gynecol Obstet 2009; 280:465-8. [PMID: 19148662 DOI: 10.1007/s00404-008-0898-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 12/09/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED A case report and review of an extraskeletal neuroectodermal tumour of the vagina. BACKGROUND Ewing's sarcoma (ES) and primitive neuroectodermal tumours (PNETs) account for approximately 6-10% of primary malignant bone tumours and, following osteosarcoma, are the second most common group of bone sarcomas in children. Ewing's sarcoma rarely affects the genitourinary tract. We report a rare case of extraskeletal Ewing's sarcoma diagnosed in a 47-year-old Indian woman presenting with a simple cystic lesion in the posterior wall of the vagina. The histopathology revealed a rare presentation of a primitive malignant extraskeletal neuroectodermal tumour. CONCLUSION As our PubMed review found only six previously reported cases of vaginal extraskeletal Ewing's sarcoma. Presentation as vaginal masses helped in early disease detection.
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Colovic RB, Grubor NM, Micev MT, Matic SV, Atkinson HDE, Latincic SM. Perigastric extraskeletal Ewing’s sarcoma: A case report. World J Gastroenterol 2009; 15:245-7. [PMID: 19132777 PMCID: PMC2653319 DOI: 10.3748/wjg.15.245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ewing’s sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES presenting with epigastric pain and weight loss. Ultrasound and computed tomography scans indicated a solid/cystic mass in the pancreatic tail. At laparotomy, the tumor was found attached to the posterior surface of the stomach, completely free from the pancreas, with no lymphadenopathy or local metastases. The polynodal, partly pseudocystic, dark-red soft tumor was excised. Histopathology revealed an anaplastic small-round-cell tumor with strong membranous CD99 immunoexpression. Additionally, there was patchy immunostaining for S-100 protein, vimentin, protein gene product (PGP) 9.5 and neuron-specific enolase, and weak focal CD117 cytoplasmic immunoreactivity. The patient had no adjuvant chemotherapy; her postoperative recovery was uneventful, and she remains symptom-free, and without any sign of recurrence at 20 mo. To the best of our knowledge, this is only the third ever case of gastric ES.
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18
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Park JY, Lee S, Kang HJ, Kim HS, Park SY. Primary Ewing's sarcoma-primitive neuroectodermal tumor of the uterus: a case report and literature review. Gynecol Oncol 2007; 106:427-32. [PMID: 17572479 DOI: 10.1016/j.ygyno.2007.04.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 04/06/2007] [Accepted: 04/06/2007] [Indexed: 12/28/2022]
Abstract
BACKGROUND Primary Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) of the uterus is an extremely rare malignancy. CASE A 30-year-old Korean woman presented with abnormal uterine bleeding with uterine enlargement. A computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen and pelvis showed a huge uterine mass measuring 18 x 20 x 21 cm, metastasis to both pelvic and para-aortic lymph nodes, and omental infiltration. The pathology report of the uterine mass described a uniformly hypercellular tumor, which was arranged in diffuse solid sheets of uniform, small, rounded, and sometimes spindle-shaped cells, with scanty cytoplasm. Immunohistochemically, the mass tested positive for vimentin, CD99, and chromogranin. The patient received several courses of combination chemotherapy and radiotherapy but died from tumor progression 16 months after the initial diagnosis. CONCLUSION(S) This is a rare case of primary uterine ES-PNET in a woman of reproductive age. A review of the literature indicates that primary uterine ES-PNET requires early diagnosis and multimodality treatment including surgery, chemotherapy, and radiotherapy. The behavior of this tumor is potentially aggressive.
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Affiliation(s)
- Jeong-Yeol Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do, 411-351, Korea
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19
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Abstract
Extraosseous Ewing's sarcoma of the vulva is extremely rare with only three such cases described. A 26-year-old woman presented with Ewing's sarcoma of the vulva. She received chemotherapy to shrink the lesion. However, the response was suboptimal and she subsequently received radiotherapy. Although resection was planned, she developed chest metastases within a short period of time and subsequently died.
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Affiliation(s)
- M Moodley
- Gynaecology Oncology, Subdivision of the Department of Obstetrics & Gynaecology and Department of Radiation Oncology, Nelson R. Mandela School of Medicine, Durban, South Africa
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20
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López C, Balogun M, Ganesan R, Olliff JF. MRI of vaginal conditions. Clin Radiol 2005; 60:648-62. [PMID: 16038691 DOI: 10.1016/j.crad.2005.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 02/03/2005] [Accepted: 02/08/2005] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, post-surgical appearances with the formation of a neovagina and adhesions) or malignant, usually due to extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies.
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Affiliation(s)
- C López
- Department of Radiology, Birmingham Women's Hospital, Birmingham, UK.
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Liao X, Xin X, Lü X. Primary Ewing's sarcoma–primitive neuroectodermal tumor of the vagina. Gynecol Oncol 2004; 92:684-8. [PMID: 14766267 DOI: 10.1016/j.ygyno.2003.10.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only three cases of Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) occurring in the vagina have been previously reported. CASE A 30-year-old Chinese woman presented with a vaginal mass measuring 5 cm in greatest dimension. The tumor was composed of solid sheets of undifferentiated small round cells with numerous Homer-Wright rosettes. Immunohistochemically, it was positive for CD99, FlI-1 protein, synaptophysin, neuron-specific enolase, vimentin, and S-100 protein. The patient underwent wide local excision of the tumor and subsequent total abdominal hysterectomy with postoperative chemotherapy and radiotherapy. She is disease-free 36 months after the initial surgery. CONCLUSION This is a rare case of ES-PNET occurring in the vagina and the first showing many distinctive Homer-Wright rosettes. A review of literature indicates that vaginal or vulvar ES-PNET affects younger women, and it may have a relatively favorable outcome.
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Affiliation(s)
- Xiaoyun Liao
- Department of Pathology, Peking University People's Hospital, Beijing 100044, PR China.
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Gaona-Luviano P, Unda-Franco E, González-Jara L, Romero P, Medina-Franco H. Primitive neuroectodermal tumor of the vagina. Gynecol Oncol 2003; 91:456-8. [PMID: 14599885 DOI: 10.1016/s0090-8258(03)00500-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Primitive neuroectodermal tumor is grouped together with Ewing sarcoma of the bone, but its presentation includes a wider age range and more central locations than its osseous counterpart. Presentation in vagina is exceedingly rare. CASE A 34-year-old woman with personal history of kidney transplant presented with a painless vaginal mass. After surgical excision, pathology results demonstrated a primitive neuroectodermal tumor. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy. After 20 months postexcision, there is no clinical nor radiographic evidence of recurrence. CONCLUSIONS This is the second case of primitive neuroectodermal tumor located in the vagina reported in the literature.
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Affiliation(s)
- Patricia Gaona-Luviano
- Department of Gynecology, Nacional Institute of Medical Sciences and Nutrition "Salvador Zubirán," Mexico City, Mexico
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