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Ali A, Shahbaz U, Nadeem A, Umar S, Ahmed A. Abdominal distention, immunopositivity, and aggressive nature: A rare Ewing's sarcoma of the adrenal gland. Radiol Case Rep 2024; 19:1935-1939. [PMID: 38449484 PMCID: PMC10915781 DOI: 10.1016/j.radcr.2024.02.024] [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: 10/19/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
This case report describes a 32-year-old Pakistani male patient with an Ewing sarcoma (ES) of the adrenal gland. Presenting complaints were abdominal distention, pain, low-grade fever, and weight loss. Initial studies, including imaging and tumor markers, ruled out any other possible origins of the mass. A percutaneous biopsy verified the tumor's neuroendocrine origin. Extensive involvement of nearby anatomical structures was discovered through exploratory laparotomy, rendering total resection difficult. Based on the presence of malignant, round, blue cells that were positive for specific immunostaining markers, the histopathology report supported the diagnosis of an ES with a staging of T3N0M0. Chemotherapy, in accordance with the VAC-IE protocol, was administered after debulking surgery. Subsequent imaging and close monitoring revealed no metastatic or residual tumors. Adrenal ES is an uncommon, aggressive tumor that mandates prompt diagnosis and management. This case report highlights the value of early detection and multimodal therapy in enhancing patient outcomes for this rare malignancy.
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Affiliation(s)
- Anam Ali
- Department of Medicine, Jinnah Hospital, Allama Shabbir Ahmad Usmani Road, Lahore, Punjab, Pakistan
| | - Usman Shahbaz
- Department of Medicine, Jinnah Hospital, Allama Shabbir Ahmad Usmani Road, Lahore, Punjab, Pakistan
| | - Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Lahore, Punjab, Pakistan
| | - Sumayya Umar
- Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Lahore, Punjab, Pakistan
| | - Abdullah Ahmed
- Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Lahore, Punjab, Pakistan
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Manatakis DK, Tsouknidas I, Mylonakis E, Tasis N, Antonopoulou MI, Acheimastos V, Mastoropoulou A, Korkolis DP. Primary adrenal Ewing sarcoma: A systematic review of the literature. World J Clin Cases 2023; 11:6782-6791. [PMID: 37900999 PMCID: PMC10600854 DOI: 10.12998/wjcc.v11.i28.6782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland. AIM To present a comprehensive review of primary adrenal ES, with emphasis on diagnosis, therapy and oncological outcomes. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. PubMed/ MEDLINE, EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor (PNET) of the adrenal gland. PubMed, Google Scholar and EMBASE medical databases were searched, combining the terms "adrenal", "ES" and "PNET". Demographic, clinical, pathological and oncological data of patients were analyzed by SPSS version 29.0. RESULTS A total of 52 studies were included for review (47 case reports and 5 case series) with 66 patients reported to have primary adrenal ES. Mean age at diagnosis was 26.4 ± 15.4 years (37.9% males, 57.6% females, sex not reported in 3 cases). The most frequent complaint was abdominal/flank pain or discomfort (46.4%) followed by a palpable mass (25.0%), and the average duration of symptoms was 2.6 ± 3.1 mo. The imaging modality of choice was computed tomography scan (81.5%), followed by magnetic resonance imaging (20.4%). Preoperative staging revealed that 17 tumors (27.9%) were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis. Open adrenalectomy was performed in the majority of cases (80.0%), of which 27.9% required more extensive resection. Minimally invasive surgery was attempted in 8.2% of tumors. Complete surgical resection was achieved in 89.4% of the patients. Adjuvant therapy was administered to 32 patients, in the form of chemotherapy (62.5%), radiotherapy (3.1%) or combination (34.4%). Median overall survival was 15 mo and 24-mo overall survival was 40.5%. Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%. CONCLUSION The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes. ES remains an aggressive tumor with a poor prognosis and high mortality.
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Affiliation(s)
| | - Ioannis Tsouknidas
- General Surgery, Lankenau Medical Center, Main Line Health, Wynnewood, PA 19096, United States
| | - Emmanouil Mylonakis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens 11521, Greece
| | - Nikolaos Tasis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens 11521, Greece
- Department of Surgical Oncology, St Savvas Cancer Hospital, Athens 11522, Greece
| | | | | | | | - Dimitrios P Korkolis
- Department of Surgical Oncology, St Savvas Cancer Hospital, Athens 11522, Greece
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Wright A, Desai M, Bolan CW, Badawy M, Guccione J, Rao Korivi B, Pickhardt PJ, Mellnick VM, Lubner MG, Chen L, Elsayes KM. Extraskeletal Ewing Sarcoma from Head to Toe: Multimodality Imaging Review. Radiographics 2022; 42:1145-1160. [PMID: 35622491 DOI: 10.1148/rg.210226] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare subtype in the Ewing sarcoma family of tumors (ESFT), which also includes Ewing sarcoma of bone (ESB) and, more recently, primitive neuroectodermal tumors. Although these tumors often have different manifestations, they are grouped on the basis of common genetic translocation and diagnosis from specific molecular and immunohistochemical features. While the large majority of ESFT cases occur in children and in bones, approximately 25% originate outside the skeleton as EES. Importantly, in the adult population these extraskeletal tumors are more common than ESB. Imaging findings of EES tumors are generally nonspecific, with some variation based on location and the tissues involved. A large tumor with central necrosis that does not cross the midline is typical. Despite often nonspecific findings, imaging plays an important role in the evaluation and management of ESFT, with MRI frequently the preferred imaging modality for primary tumor assessment and local staging. Chest CT and fluorine 18 fluorodeoxyglucose PET/CT are most sensitive for detecting lung and other distant or nodal metastases. Management often involves chemotherapy with local surgical excision, when possible. A multidisciplinary treatment approach should be used given the propensity for large tumor size and local invasion, which can make resection difficult. Despite limited data, outcomes are similar to those of other ESFT cases, with 5-year survival exceeding 80%. However, with metastatic disease, the long-term prognosis is poor. ©RSNA, 2022.
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Affiliation(s)
- Alexandra Wright
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Madhura Desai
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Candice W Bolan
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Mohamed Badawy
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Jeffrey Guccione
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Brinda Rao Korivi
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Perry J Pickhardt
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Vincent M Mellnick
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Meghan G Lubner
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Longwen Chen
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Khaled M Elsayes
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
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