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Das J, Nath J, R C, Rahaman M, Ahmed S. Ewing's Sarcoma of the Orbit: A Case Report and Literature Review. Cureus 2023; 15:e48592. [PMID: 37954624 PMCID: PMC10640384 DOI: 10.7759/cureus.48592] [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] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
Ewing's sarcoma (ES) is a malignant small round cell neuroectodermal tumour primarily affecting children in the first and second decade of life. Since ES is difficult to control, early diagnosis is crucial, and the treatment requires a multimodality approach constituting chemotherapy, surgery and radiotherapy. Here, we present a case of ES of orbit in a 17-year-old female diagnosed in 2021. This case report focuses on the clinicopathological presentation and management principles of this rare manifestation of the disease that unilaterally infiltrated into the extraconal space of the orbit as well as the I/L frontal sinus. The patient underwent chemotherapy and radiation, and she is on follow-up.
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Affiliation(s)
- Jahnabi Das
- Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Chandramouli R
- Department of Radiation Oncology, Krishna Cancer Institute, Cuddalore, IND
| | - Mostafijur Rahaman
- Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Shiraj Ahmed
- Department of Pathology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
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2
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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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3
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Ravina K, Windermere SA, Zhao Q, Lerner A, Dyer M, Upadhyay U, Jha RT. Primary intracranial extraosseous Ewing's sarcoma of the skull base in an elderly adult: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22214. [PMID: 36254353 PMCID: PMC9576031 DOI: 10.3171/case22214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary extraosseous intracranial Ewing's sarcoma, also known as a peripheral primitive neuroectodermal tumor or "small round blue cell tumor," is an extremely rare entity with limited representation in the literature beyond the pediatric population. OBSERVATIONS A 67-year-old male suffering occipital headache, nausea, and gait disturbance was found to have a large, avidly contrast-enhancing cerebellopontine angle mass extending into the cervical spinal canal with associated mass effect on medulla, cerebellum, fourth ventricle, and cervical spinal cord. This mass was not present on the imaging from 8 years prior. He underwent surgical debulking and pathology results demonstrated a malignant small round cell tumor showing diffuse immunopositivity for cytokeratins, CD99 and NKX2.2 with EWRS1-FLI1 rearrangement in 84% of the nuclei confirmatory of Ewing's sarcoma. After 14 cycles of chemotherapy and 6 weeks of radiotherapy, 22 months after discovery, the patient remains in clinical and radiographic remission with complete return to his baseline functioning. LESSONS Primary skull base extraosseous Ewing's sarcoma should be considered in the differential diagnosis even in the elderly population when imaging studies demonstrate aggressive tumor growth patterns. Tumor debulking to establish a diagnosis followed by adjuvant chemoradiation therapy can result in clinical improvement with remission.
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Affiliation(s)
| | | | - Qing Zhao
- Departments of Pathology & Laboratory Medicine and
| | - Adam Lerner
- Department of Medicine, Section of Hematology/Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael Dyer
- Radiation Oncology, Boston Medical Center, Boston, Massachusetts; and
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Elbaroody M, Abdullah A. Primary intracranial Ewing’s sarcoma/peripheral primitive neuroectodermal tumor in pediatric age group: A comprehensive review of literature. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_198_21] [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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Koka K, Rahim FE, El-Hadad C, Bell D, Debnam JM, Guo Y, Esmaeli B. Primary Ewing's sarcoma with orbit involvement: Survival and visual outcomes after eye-sparing multidisciplinary management in eight patients. Head Neck 2021; 43:3857-3865. [PMID: 34632670 DOI: 10.1002/hed.26884] [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: 02/08/2021] [Revised: 08/13/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To describe the clinical presentation, treatment, and overall prognosis in eight patients with primary Ewing's sarcoma (ES) involving the orbit. METHODS A retrospective interventional study of all biopsy-proven cases of primary ES involving the orbit was done. RESULTS There were seven males and one female with a median age of 14 years. Imaging showed osseous involvement in all eight cases with extraorbital extension in four. Complete tumor resection was done in four, partial resection in three, and biopsy followed by sinus surgery in one. EWSR1 gene rearrangement analysis was done to confirm diagnosis. All patients received multidrug systemic chemotherapy and seven patients received adjuvant radiotherapy. Eye salvage was achieved in all patients. At a mean follow-up duration of 52.63 months, seven patients were doing well with no evidence of disease. CONCLUSIONS ES involving the orbit is sensitive to chemotherapy and radiation. Aggressive multimodality treatment can help salvage the globe and improve overall survival.
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Affiliation(s)
- Kirthi Koka
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Farrah E Rahim
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Christian El-Hadad
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Diana Bell
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - J Matthew Debnam
- Department of Neuroradiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Yunxia Guo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Huguenard AL, Li YD, Sharifai N, Perkins SM, Dahiya S, Chicoine MR. Multifocal primary central nervous system Ewing sarcoma presenting with intracranial hemorrhage and leptomeningeal dissemination: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2042. [PMID: 35855436 PMCID: PMC9241201 DOI: 10.3171/case2042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Ewing sarcoma is a neoplasm within the family of small round blue cell tumors and most frequently arises from skeletal bone. Primary involvement of the central nervous system in these lesions is extremely rare, with an incidence of 1%. OBSERVATIONS A case is presented of a 34-year-old man who presented with left facial numbness, multiple intracranial lesions, a lumbar intradural lesion, and diffuse spinal leptomeningeal involvement. A lumbar laminectomy and biopsy were performed, which revealed the diagnosis of extraskeletal Ewing sarcoma/primitive neuroectodermal tumor. The patient had a rapidly progressive clinical decline despite total neuroaxis radiation and multiple lines of chemotherapeutic treatments, eventually dying from his disease and its sequelae 6 months after diagnosis. LESSONS The authors' review of 40 cases in the literature revealed only 2 patients with isolated intraaxial cranial lesions, 4 patients with cranial and spine involvement, and an additional 34 patients with spine lesions. The unique characteristics of this patient's case, including his presentation with diffuse disease and pathology that included a rare V600E BRAF mutation, are discussed in the context of the available literature.
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Martin E, Senders JT, ter Wengel PV, Smith TR, Broekman MLD. Treatment and survival of osteosarcoma and Ewing sarcoma of the skull: a SEER database analysis. Acta Neurochir (Wien) 2019; 161:317-325. [PMID: 30578430 PMCID: PMC6373276 DOI: 10.1007/s00701-018-3754-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
Abstract
Background Common primary bone tumors include osteosarcomas (OSC) and Ewing sarcomas (EWS). The skull is a rare site, and literature about their treatment and survival is scarce. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study aims to assess the treatment and survival of skull OSC and skull EWS, as well as predictors for survival. Methods Skull OSC and EWS cases were obtained from the SEER database. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using multivariable Cox proportional hazard regression stratified by tumor histology. Kaplan-Meier curves were constructed for OS comparing OSC and EWS, as well as histological subtypes in OSC. Results A total of 321 skull OSC and 80 skull EWS patients were registered from 1973 to 2013. EWS was more common in younger patients (p < 0.001). Resection was the predominant treatment strategy (80.1%), frequently in combination with adjuvant radiotherapy (30.4%). The 5-year survival rate varied significantly between OSC and EWS (51.0% versus 68.5%, p = 0.02). Kaplan-Meier curves show that EWS had a significantly better survival compared to OSC. Comparing histological subtypes of skull OSC, chondroblastic OSC had the best OS, Paget OSC the worst. Older age, tumor advancement, no surgical treatment, and the use of radiotherapy were identified as independent predictors of decreased OS in skull OSC. Conclusion Overall prognosis is better for EWS compared to OSC. Chondroblastic OSC have the best overall survival, while OSC associated with Paget’s disease of the bone has the poorest overall survival.
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Aydin S, Yuksel O, Tanritanir R, Aydin AE, Celik SE. Primary Ewing Sarcoma of Frontotemporal Bone in Geriatric Patient. World Neurosurg 2018; 115:278-281. [PMID: 29715573 DOI: 10.1016/j.wneu.2018.04.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ewing sarcoma is a rare primary malignant bone tumor, which mainly affects children and adolescents. Calvarial bone involvement and its appearance in elderly patients are extremely rare. CASE DESCRIPTION We presented a 68-year-old female patient with headache and right frontotemporal swelling. Imaging studies showed a right frontotemporal mass expanding to the Sylvian fissure. The patient underwent total resection of the mass, and pathologic evaluation ensured the diagnosis of primary Ewing sarcoma. The patient had adjuvant radiotherapy and chemotherapy after surgery. CONCLUSIONS Prognosis and efficiency of treatment for primary Ewing sarcoma of skull are unclear in elderly patients because of the sarcoma's rare appearance. Therefore more clinical evaluation is necessary. This case is the oldest patient presented in the literature.
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Affiliation(s)
- Seckin Aydin
- Department of Neurosurgery, T. C. Ministry of Health Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Odhan Yuksel
- Department of Neurosurgery, Aspendos Anadolu Hospital, Antalya, Turkey.
| | - Rahime Tanritanir
- Department of Pathology, T. C. Ministry of Health Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Aysegul Esen Aydin
- T. C. Ministry of Health Bakirkoy Research and Training Hospital for Neurology Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Suat Erol Celik
- Department of Neurosurgery, T. C. Ministry of Health Okmeydani Education and Research Hospital, Istanbul, Turkey
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A review of nasal, paranasal, and skull base tumors invading the orbit. Surv Ophthalmol 2017; 63:389-405. [PMID: 28739401 DOI: 10.1016/j.survophthal.2017.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
Abstract
Tumors that invade the orbit are uncommon. The majority are meningiomas arising from the sphenoid ridge (66%). Others are bone and cartilage tumors arising from the surrounding bones of the orbit, pituitary adenomas, and epithelial tumors arising from the paranasal sinuses and nasal cavity. Meningiomas occur more often in women, whereas epithelial tumors have a predilection for men. Meningiomas and epithelial tumors typically present in the sixth decade of life, whereas bone tumors tend to affect individuals in their third decade of life. Patients often present with a combination of ophthalmological and otorhinolaryngological symptoms, including proptosis, pain, decreased visual acuity, restrictions in motility of the eye, epistaxis, and nasal obstruction. Sarcomas and benign bone and cartilage tumors arise from surrounding structures, whereas carcinomas usually arise from the paranasal sinuses. Surgery is the mainstay of treatment. Depending on the aggressiveness and histology of the tumor, surgery may be combined with radiation and chemotherapy. The prognosis is generally poor, but varies depending on histology and cell origin, size of the tumor, and degree of invasion. Meningiomas and benign bone tumors have the best prognoses. Sinonasal undifferentiated carcinomas, small-cell neuroendocrine carcinomas, osteosarcomas, and rhabdomyosarcomas have poorer prognoses.
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Abstract
In the span of the last 48 years, only 33 cases of children with orbital Ewing sarcoma have been reported. This study is to present 3 cases that were admitted to Children's Cancer Hospital Egypt 57357, during the period from 2009 to 2013. We have 2 cases treated using the hospital standard Ewing sarcoma treatment protocol, to completion, whereas the third discontinued treatment. All tumors have confirmed CD99 positivity, although translocation (11;22) was positive in 1 patient and negative in the third. With earlier diagnosis and adequate surgical resection and integration of chemotherapy and radiotherapy 1 patient survived for about 4 years, whereas the other 2 cases died due to disease progression or recurrence.
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11
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Ibrahim GM, Fallah A, Shahideh M, Tabori U, Rutka JT. Primary Ewing's sarcoma affecting the central nervous system: a review and proposed prognostic considerations. J Clin Neurosci 2011; 19:203-9. [PMID: 22024233 DOI: 10.1016/j.jocn.2011.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/21/2011] [Indexed: 10/15/2022]
Abstract
Ewing's sarcoma (ES) is a part of a larger family of round blue cell tumors, which occasionally manifest as osseous or extraosseous lesions adjacent to or within the central nervous system (CNS). While a large body of literature exists on ES of bone, data are lacking on tumors with cranial or spinal components that affect the CNS. Here, we perform a systematic review of the literature and summarize the best available evidence on diagnosis, treatment and outcomes of ES affecting the CNS with emphasis on the breadth of clinical presentations, diagnostic tools and emerging management options for these rare and challenging lesions. We include a review of known prognostic factors and propose several new considerations for prognostication of ES affecting the CNS.
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Affiliation(s)
- George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Suite 1503, 555 University Avenue, Toronto, Ontario M5G 1X9, Canada.
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Nair AP, Bettaswamy G, Jaiswal AK, Garg P, Jaiswal S, Behari S. Ewing's sarcoma of the orbit with intracranial extension: A rare cause of unilateral proptosis. J Pediatr Neurosci 2011; 6:36-9. [PMID: 21977086 PMCID: PMC3173912 DOI: 10.4103/1817-1745.84405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Ewing's sarcoma causing unilateral proptosis along with bifrontal extradural infiltration in a child is an unusual presentation. A female patient presented with features of painless proptosis of the left eye with visual deterioration. Her radiology revealed an infiltrating intraorbital, extraconal tumor with intracranial bifrontal extradural extension causing mass effect. Total excision of the intraorbital and intracranial part of the tumor along with postoperative chemo- and radiotherapy brought about a substantial relief. The clinicoradiological presentation and management of this rare entity are discussed.
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Affiliation(s)
- Anup P Nair
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Allam A, El-Husseiny G, Khafaga Y, Kandil A, Gray A, Ezzat A, Schultz H. Ewing's Sarcoma of the Head and Neck: A Retrospective Analysis of 24 Cases. Sarcoma 2011; 3:11-5. [PMID: 18521259 PMCID: PMC2395405 DOI: 10.1080/13577149977811] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction and purpose. Primary Ewing's sarcoma arising from the
bones of the head and neck region is extremely rare representing only 1– 4% of all Ewing's
sarcoma cases. Previous reports suggest a better prognosis for that particular anatomic site.
The purpose of this study was to analyze the clinico-epidemiologic characteristics of that rare clinical presentation, as
well as its patterns of failure and prognosis following treatment. Materials and methods. This study included a retrospective review of the medical records
of patients with the diagnosis of Ewing's sarcoma of the head and neck region treated at King
Faisal Specialist Hospital and Research Center between 1975 and 1996. Results. Out of a total number of 24 cases analyzed, there were 17 males and
7 females with a ratio of 2.4:1. The median age at diagnosis was 16.5 years. A painful swelling was
the most common clinical presentation.The maxilla was the most common site of presentation
(9/24 cases). There were 3/24 cases who presented with metastatic disease at diagnosis.The
majority of patients (16/24 cases) had a tumor size >10 cm. Most patients were treated with systemic
chemotherapy plus localized irradiation following an initial biopsy.With a mean follow
up of 3.4 years, the 5-year actual overall survival (OS) for the whole group was 53%, while
the 5-year actuarial disease-free survival (DFS) was 30%. These figures were higher than those
repor ted from our institution for young patients (≤ 14 years treated for Ewing' s sarcoma in other
anatomic locations (30% v 15%). The response to chemotherapy was the only prognostic factor
that affected both the OS and DFS. Conclusion. The prognosis of Ewing's sarcoma of the head and neck
region is slightly better than that of other anatomic sites.The response to systemic chemotherapy
is one of the most important prognostic factors affecting both DFS and OS of Ewing's sarcoma of
the head and neck. Multimodality therapy consisting of an initial biopsy, aggressive combination
chemotherapy and localized radiotherapy is the treatment of choice for Ewing's sarcoma of
the head and neck region and may result in long-term survival.
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Affiliation(s)
- A Allam
- Department of Radiation Oncology King Faisal Specialist Hospital and Research Center PO Box 3354 Riyadh 11211 Saudi Arabia
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Weiss R, Walz PH. Peripheral primitive neuroectodermal tumour in a lumbar vertebra and the liver of a dromedary camel (Camelus dromedarius). J Comp Pathol 2009; 141:182-6. [PMID: 19446834 DOI: 10.1016/j.jcpa.2008.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 11/04/2008] [Indexed: 01/06/2023]
Abstract
A 9-year-old castrated male dromedary camel developed weakness and ataxia, progressing to sternal recumbency and hindlimb paralysis. Necropsy revealed multiple liver tumours and a mass in the 3rd lumbar vertebra, compressing the spinal cord. The hepatic and vertebral masses consisted of uniform sheets of primitive cells, with perivascular pseudorosettes and small numbers of neuroblastic Homer-Wright rosettes. Immunohistochemically, the tumour cells were uniformly positive for vimentin and variably positive for neuron-specific enolase and glial fibrillary acidic protein. The histopathological and immunohistochemical findings indicated a peripheral primitive neuroectodermal tumour (pPNET) exhibiting neuroblastic, glial and ependymomatous differentiation, probably reflecting the tumour's primitive multipotential neuroepithelial nature. To the authors' knowledge, this is the first reported case in the camel of a pPNET, presumably intraosseous in origin with hepatic metastasis, and morphologically similar to Ewing's sarcoma in man.
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Affiliation(s)
- R Weiss
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Alabama 36849, USA.
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Sato S, Mitsuyama T, Ishii A, Kawakami M, Kawamata T. Multiple primary cranial Ewing's sarcoma in adulthood: case report. Neurosurgery 2009; 64:E384-6; discussion E386. [PMID: 19190443 DOI: 10.1227/01.neu.0000337128.67045.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Ewing's sarcoma is a malignant bone tumor occurring most frequently in the long bones and flat bones as a solitary lesion during the first 2 decades of life. Ewing's sarcoma and peripheral primitive neuroectodermal tumor have recently been considered to be the same entity because of histological and molecular similarities. CLINICAL PRESENTATION A 25-year-old man presented with swelling in the right parietal region. Magnetic resonance imaging scans showed 2 mixed intense mass lesions in the right parietal and left frontal areas with heterogeneous gadolinium enhancement. A computed tomographic scan revealed osteolytic changes of the inner calvarial bone. Ga-67 citrate scintigraphy demonstrated abnormal uptake in the right parietal and the left frontal areas consistent with the findings on magnetic resonance imaging scans. There was no uptake lesion beyond the cranium. The patient underwent surgical excision of the right parietal lesion. INTERVENTION Histological examinations showed densely packed, small round cells with rosette formation. The cells had scanty clear cytoplasm, and regular vesicular and hyperchromatic nuclei. Electron microscopy showed little differentiation to neuronal tissue, indicating Ewing's sarcoma. After surgical treatment, conventional whole cranial irradiation of 40 Gy and chemotherapy were conducted. The tumor in the left frontal region disappeared. Follow-up examinations showed no evidence of recurrence 1 year after the surgery. CONCLUSION Although quite rare, Ewing's sarcoma should be taken into consideration as a differential diagnosis of multiple cranial mass lesions in adulthood.
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Affiliation(s)
- Shinsuke Sato
- Department of Neurosurgery, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan
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Gupta N, Bansal D, Saxena AK, Srinivasan R, Marwaha RK. Primary orbital Ewing's sarcoma presenting with unilateral proptosis. Cytopathology 2008; 19:124-6. [DOI: 10.1111/j.1365-2303.2006.00422.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
A 42-year-old man presented with visual field loss in the right eye and unintentional weight loss associated with a right orbital mass. Surgical resection and biopsy revealed a diagnosis of Ewing sarcoma, and systemic evaluation showed no metastasis. Subsequent chemotherapy and radiation resulted in tumor resolution without recurrence for 3.5 years. Although systemic symptoms are associated with a poorer prognosis, longer survival may be possible in the absence of metastasis.
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Affiliation(s)
- Noelene K Pang
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
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Kasliwal MK, Agrawal D, Mahapatra AK. Magnetic resonance imaging of primary orbital Ewing's sarcoma. Pediatr Neurosurg 2005; 41:192-6. [PMID: 16088254 DOI: 10.1159/000086560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Accepted: 12/29/2004] [Indexed: 11/19/2022]
Abstract
The authors describe the MRI findings of a primary orbital Ewing's sarcoma in a 5-year-old boy, who underwent an extensive tumour surgery as these findings were mistaken for more chemoresistant sarcomas such as rhabdomyosarcoma. This case illustrates the fact that MR findings of primary orbital Ewing's sarcoma may be different from those of Ewing's sarcoma present elsewhere in the body. An accurate preoperative diagnosis may therefore result in a more conservative approach and prove extremely useful in such tumours.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
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Sharma A, Garg A, Mishra NK, Gaikwad SB, Sharma MC, Gupta V, Suri A. Primary Ewing's sarcoma of the sphenoid bone with unusual imaging features: a case report. Clin Neurol Neurosurg 2004; 107:528-31. [PMID: 16202829 DOI: 10.1016/j.clineuro.2004.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 10/16/2004] [Accepted: 11/08/2004] [Indexed: 11/29/2022]
Abstract
Ewing's sarcomas (ES) account for approximately 10% of primary malignant bone tumors. Primary Ewing's sarcoma of the skull is a very rare entity. We report a case of Ewing's sarcoma of the sphenoid bone in a 5-year-old boy. CT scan showed heterogeneously enhancing mass with associated spiculated new bone formation along the posterolateral wall of the orbit. Magnetic resonance (MR) imaging showed markedly heterogeneously signal intensity mass lesion containing areas of hemorrhage and fluid-fluid levels. Spiculated new bone formation and fluid-fluid levels had not been reported previously in skull Ewing's sarcomas and may be helpful features for preoperative diagnosis.
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Affiliation(s)
- Ashwani Sharma
- Department of NeuroRadiology, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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20
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Abstract
Primary tumors of orbital bone constitute 0.6% to 2% of all orbital tumors. Our experience over a 24-year period in the Orbital Clinic at the University of British Columbia yielded 62 (1.9%) cases from a total of 3,340 orbital tumors. Although a heterogeneous group, primary orbital bone tumors may be classified on a clinicopathologic basis into benign fibro-osseous or cartilaginous, reactive, neoplastic and vascular disorders. Presentation is usually a gradual mass effect, with infiltration and acute hemorrhage being features of malignant and reactive lesions respectively. The two most commonly encountered entities were fibrous dysplasia and osteoma, accounting for 22 cases. Although both these conditions rarely present a diagnostic challenge, nonspecific histologic and radiologic appearances can result in poor characterization of several of the rarer lesions. Hence, close cooperation between clinician, radiologist and pathologist is essential for accurate diagnosis.
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Affiliation(s)
- Dinesh Selva
- Department of Ophthalmology, University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
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21
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Singh P, Jain M, Singh DP, Kalra N, Khandelwal N, Suri S. MR findings of primary Ewing's sarcoma of greater wing of sphenoid. AUSTRALASIAN RADIOLOGY 2002; 46:409-11. [PMID: 12452913 DOI: 10.1046/j.1440-1673.2002.01086.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary Ewing's sarcoma of the skull is a very rare entity. We report MRI findings in a case of Ewing's sarcoma of the greater wing of sphenoid in a 4-year-old patient. Magnetic resonance imaging showed markedly heterogenous signal intensity with areas of haemorrhage and necrosis. It also demonstrated the exact extent of tumour due to its multiplanar capabilities and was, therefore, helpful in planning surgery.
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22
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Erol FS, Ozveren MF, Ozercan IH, Topsakal C, Akdemir I. Primary Ewing's sarcoma of the occipital bone--case report. Neurol Med Chir (Tokyo) 2001; 41:206-9. [PMID: 11381680 DOI: 10.2176/nmc.41.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 17-year-old female presented with a very rare case of primary Ewing's sarcoma of the skull involving the occipitotemporal region. Systemic examination found no evidence of metastasis. The tumor was surgically removed, and the patient underwent radiotherapy and chemotherapy. Fourteen months after surgery there has been no recurrence of the tumor. Cranial primary Ewing's tumor has a good prognosis after radical surgery and adjuvant therapy.
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Affiliation(s)
- F S Erol
- Department of Neurosurgery, School of Medicine, University of Firat, Elazig, Turkey
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23
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Abstract
PURPOSE Ewing's tumor is a primary tumor of bone in childhood that only rarely involves the orbit. Most such cases are metastatic from distant sites. This tumor may be confused with other small round cell malignancies of childhood, and immunohistochemical studies are essential in making the diagnosis. METHODS We present two cases of Ewing's tumor of the orbit. One was in a 22-year-old boy with an occult primary tumor in the frontal bone that became symptomatic after forehead trauma. The other example was in a 7-year-old boy with a known Ewing's primary of the clavicle. The clinical manifestations and diagnostic criteria are discussed. RESULTS In most cases with orbital involvement, ophthalmic symptoms consist of proptosis, pain, and occasionally visual loss and motility restriction. The diagnosis is typically unsuspected before histologic evaluation. Electron microscopic and immunohistochemical analyses are essential in making the diagnosis and are necessary for all such small round cell tumors. CONCLUSIONS Ewing's sarcoma is a rare orbital tumor of bone mainly affecting children. Local treatment relying on surgical extirpation and radiotherapy alone has proven inadequate, with 5-year survival rates of <10%. The addition of chemotherapy has improved survival rates significantly to approximately 50%.
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Affiliation(s)
- J J Dutton
- The Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA
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24
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25
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Desai KI, Nadkarni TD, Goel A, Muzumdar DP, Naresh KN, Nair CN. Primary Ewing's Sarcoma of the Cranium. Neurosurgery 2000. [DOI: 10.1093/neurosurgery/46.1.62] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ketan I. Desai
- Department of Neurosurgery King Edward Memorial Hospital, Seth G.S. Medical College
| | - Trimurti D. Nadkarni
- Department of Neurosurgery King Edward Memorial Hospital, Seth G.S. Medical College
| | - Atul Goel
- Department of Neurosurgery King Edward Memorial Hospital, Seth G.S. Medical College
| | | | | | - Chandrika N. Nair
- Department of Medical Oncology Tata Memorial Hospital, Parel, Mumbai, India
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26
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Lam DS, Li CK, Cheng LL, Teo JG, Chik KW, Kwan WH, Ng JS, Poon WW, Yuen PM. Primary orbital Ewing's sarcoma: report of a case and review of the literature. Eye (Lond) 1999; 13 ( Pt 1):38-42. [PMID: 10396382 DOI: 10.1038/eye.1999.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Primary orbital Ewing's sarcoma is a very rare condition. Since the first case was reported in 1950, only 7 other cases have been reported in the English literature. Herein we describe the ninth, the only bilateral and the youngest case of primary orbital Ewing's sarcoma occurring in a 2-year-old boy, who presented to us with bilateral painless proptosis. Tissue biopsy of the tumour was obtained through the nasal sinus. Immunohistological studies of the biopsy tissue confirmed the diagnosis of Ewing's sarcoma. No distant site of the tumour was found so this was considered a primary orbital tumour. Combined chemotherapy and radiotherapy without surgical resection achieved an encouraging result in that the patient has remained in remission for 30 months after completion of treatment. The successful use of combined chemotherapy and radiotherapy, without surgery, adds further support to evidence that surgical excision may be avoided in selected cases of primary orbital Ewing's sarcoma.
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Affiliation(s)
- D S Lam
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T.
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27
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Kuzeyli K, Aktürk F, Reis A, Cakir E, Baykal S, Pekínce A, Usul H, Söylev AE. Primary Ewing's sarcoma of the temporal bone with intracranial, extracranial and intraorbital extension. Case report. Neurosurg Rev 1997; 20:132-4. [PMID: 9226674 DOI: 10.1007/bf01138198] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Primary cranial Ewing's sarcoma is a very rare malignant tumor. Primary temporal bone Ewing's sarcoma with intraorbital extension is also a very rare condition. In this article we describe a case of primary Ewing's sarcoma of the temporal bone which extended into intracranial, extracranial and intraorbital compartments; manifesting with a swelling in the zygomatic fossa and proptosis of the right eye. The tumor was excised partially, and the patient underwent radiochemotherapy. The patient died 6 months after the therapy, with lung metastasis. The case is discussed with the pertinent literature.
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Affiliation(s)
- K Kuzeyli
- K.T.U. Medical Faculty Department of Neurosurgery, Trabzon, Turkey
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28
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Stechschulte SU, Kepes JJ, Holladay FP, McKittrick RJ. Primary Meningeal Extraosseous Ewing??s Sarcoma. Neurosurgery 1994. [DOI: 10.1097/00006123-199407000-00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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Stechschulte SU, Kepes JJ, Holladay FP, McKittrick RJ. Primary meningeal extraosseous Ewing's sarcoma: case report. Neurosurgery 1994; 35:143-7. [PMID: 7936137 DOI: 10.1227/00006123-199407000-00023] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 25-year-old man presented with a suspected right-sided subdural hematoma after a skiing accident. A large hemorrhagic mass was found and was evacuated. Histological studies demonstrated a highly cellular neoplasm with extensive hemorrhage. Further histological, immunohistochemical (including staining for Ewing's sarcoma cell surface antigen), and ultrastructural analyses of the tumor were consistent with Ewing's sarcoma. Search for other foci of this neoplasm by bone scan, full body computed tomographic scans, magnetic resonance imaging scans of the spine, and a bone marrow aspiration with biopsy failed to detect any soft tissue or bony involvement outside the cranium. This case appears to represent the first report of a primary extraosseous Ewing's sarcoma occupying the cranial subdural area.
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Affiliation(s)
- S U Stechschulte
- Department of Medicine, University of Kansas Medical Center, Kansas City
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30
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Tournut P, Turjman F, Laharotte JC, Froment JC, Gharbi S, Duquesnel J. Primary Ewing's sarcoma of the skull presenting as an acute surgical emergency. Childs Nerv Syst 1994; 10:193-4. [PMID: 8044818 DOI: 10.1007/bf00301090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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31
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Mishra HB, Haran RP, Joseph T, Chandi SM. Primary Ewing's sarcoma of the skull. A report of two cases. Br J Neurosurg 1993; 7:683-6. [PMID: 8161432 DOI: 10.3109/02688699308995099] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report two cases of primary Ewing's sarcoma of the skull. The literature contains previous reports of only four such cases.
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Affiliation(s)
- H B Mishra
- Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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32
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Watanabe H, Tsubokawa T, Katayama Y, Koyama S, Nakamura S. Primary Ewing's sarcoma of the temporal bone. SURGICAL NEUROLOGY 1992; 37:54-8. [PMID: 1727085 DOI: 10.1016/0090-3019(92)90067-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary cranial Ewing's sarcoma is exceptionally rare. Only ten cases of such a tumor had been reported heretofore in the literature. We describe a case of primary Ewing's sarcoma occurring in the temporal bone. The tumor was surgically excised, and the patient underwent radiation and chemotherapy. Neither recurrence nor distant metastasis was noted at 12 months after surgery. Although the prognosis of Ewing's sarcoma in general is often poor because of early metastasis to the lungs and/or to other bones, a review of the literature suggested that the same tumor occurring in the cranium can often be successfully managed by intensive therapy with radical excision and radiochemotherapy. This inference was supported by the case reported here.
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Affiliation(s)
- H Watanabe
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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33
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Colak A, Berker M, Ozcan OE, Erbengi A. CNS involvement in Ewing's sarcoma. A report of 12 cases. Acta Neurochir (Wien) 1991; 113:48-51. [PMID: 1799143 DOI: 10.1007/bf01402114] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ewing's sarcoma is one of the malignant bone tumours, which occurs in various bones of the body. When the spinal column or skull bones are involved, it may cause spinal cord compression or brain invasion. In this study, 12 cases of Ewing's sarcoma with central nervous system (CNS) involvement are presented. Seven of them were male and five female. In seven of the cases tumoural mass was located in the spinal column, whereas in the others it was found in the cranium. The major complaints were motor weakness in the lower extremities in seven cases, and a mass on the cranial vault in four cases. On neurological examination, eight of the patients had impairment of movements of the extremities (67%), and seven had sensory loss (58%). All except one patient underwent surgery. In seven cases, decompressive laminectomy plus subtotal tumour excision was performed, in three, craniectomy with grossly total tumour excision, and in one, biopsy. In this report, age and sex distribution, complaints, clinical and laboratory findings, neurological examination, and histopathology of our cases are reviewed and surgical results are compared with others reported in the literature.
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Affiliation(s)
- A Colak
- Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey
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34
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Simpson RK, Bruner JM, Leavens ME. Metastatic Ewing's sarcoma to the brain: case report and review of treatment. SURGICAL NEUROLOGY 1989; 31:234-8. [PMID: 2922669 DOI: 10.1016/0090-3019(89)90124-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An unusual case of Ewing's sarcoma metastatic to the brain is presented. Neurosurgical intervention has a role in the treatment of patients with central nervous system metastasis of this rare tumor.
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Affiliation(s)
- R K Simpson
- Section of Neurosurgery, M. D. Anderson Hospital and Tumor Institute, Houston, Texas
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35
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Abstract
A 7-year-old girl with clinical signs limited to moderate unilateral proptosis of 2 weeks duration and ipsilateral disc edema was found to have a contiguous orbital and subfrontal intracranial tumor best characterized as a peripheral neuroepithelioma by recent studies. Previously this tumor would have been called an extraosseous Ewing's sarcoma. The tumor had a significant lobular component on either side of the orbital roof. The patient is still alive 24 months posttreatment with multimodal excisional surgery, radiation, and chemotherapy.
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Affiliation(s)
- W B Wilson
- Department of Ophthalmology, University of Colorado Health Sciences Center, Denver
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36
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Woodruff G, Thorner P, Skarf B. Primary Ewing's sarcoma of the orbit presenting with visual loss. Br J Ophthalmol 1988; 72:786-92. [PMID: 3191083 PMCID: PMC1041584 DOI: 10.1136/bjo.72.10.786] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A case of primary Ewing's sarcoma of the orbit and paranasal sinuses in a 6-yearold boy is reported. The child presented with headaches and unilateral visual loss. Loss of vision as a result of optic nerve involvement with primary Ewing's sarcoma is extremely rare.
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Affiliation(s)
- G Woodruff
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada
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37
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Abstract
Ewing's sarcoma is a rare tumor of the bone. In the Intergroup Ewing's Sarcoma Study (IESS) approximately 4% of the primary bone tumors arose in the bones of the head and neck. The mean age of patients was 10.9 years; boys slightly dominated the group. Signs and symptoms were local in distribution, with a mass or swelling most frequent. As in other sites, we categorized the dominant histologic pattern as diffuse or filigree, the latter carrying a more unfavorable prognosis. The radiographic appearance may be atypical as compared to Ewing's sarcoma at other sites. Prognosis of head and neck Ewing's is significantly better than Ewing's sarcoma overall. The gnathic bones were commonly affected, yet there was no associated mortality. No patient with primary disease in the bones of the head and neck who survived for 5 years on any of the IESS protocols has subsequently died.
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Affiliation(s)
- G P Siegal
- Department of Pathology, University of North Carolina, Chapel Hill 27599
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38
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39
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Jakobiec FA, Klepach GL, Crissman JD, Spoor TC. Primary differentiated neuroblastoma of the orbit. Ophthalmology 1987; 94:255-66. [PMID: 3587903 DOI: 10.1016/s0161-6420(87)33463-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A 49-year-old woman had a 12-year history of a localized left orbital tumor that required five subtotal excisions, orbital radiotherapy, and finally an exenteration. The last procedure was performed after visual function had deteriorated and in order to prevent spread of the tumor into a surrounding compartment. The biopsy specimens from the first four surgeries showed a stroma-free spindle cell tumor with benign cytologic features and no mitotic activity, which exhibited palisading of nuclei, imbrication of delicate cytoplasmic processes (neuropil), true perivascular rosettes with cytoplasmic processes oriented perpendicular to vessel walls, and Wright rosettes. The biopsy after radiotherapy and the exenteration specimen contained more polyhedral (gemistocytoid) tumor cells with abundant eosinophilic cytoplasm and tapering cell processes; nuclear pleomorphism without mitotic activity was also seen. Electron microscopy showed the presence of neurosecretory dense-core granules in the perikaryon region of the tumor cells and in the myriad interweaving cytoplasmic processes (neurites); neither Nissl substance nor synapses were identified. Immunohistochemical staining for neuron-specific enolase was positive, but glial fibrillary acidic protein stained negative. This previously undescribed orbital tumor is interpreted as a primary differentiated neuroblastoma without evidence of ganglion cell differentiation that exhibited locally aggressive behavior. The distinctions between neuroblastic and neuroendocrine tumors are discussed.
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