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Njima M, Lahbacha B, Ben Jabra S, Moussa A, Bellalah A, Ben Abdeljelil N, Ben Hammouda S, Njim L, Hadhri R, Zakhama A. Small Intestine Gastrointestinal Clear Cell Sarcoma: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2024; 12:23247096231225869. [PMID: 38229428 PMCID: PMC10798064 DOI: 10.1177/23247096231225869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/29/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024] Open
Abstract
Gastrointestinal clear cell sarcoma (GICCS)/malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare form of cancer with aggressive clinical behavior. It has distinct pathological, immunohistochemical, ultrastructural, and molecular features. Herein, we present the case of a 20-year-old woman with no notable medical history who presented to the outpatient department with complaints of abdominal pain and vomiting. Symptoms had been evolving for 3 months. The physical examination revealed slight abdominal tenderness and melena. Biological investigations revealed iron-deficiency anemia. The upper and lower endoscopies showed no abnormalities. Magnetic resonance enterography revealed small bowel wall thickening of 15 mm × 2 mm. Exploratory laparotomy revealed an ileal mass with mesenteric lymphadenopathy. A wide resection of the mass was then performed. The final pathological report confirmed the diagnosis of small bowel GICCS/GNET. After 11 months of follow-up, the patient presented with mesenteric lymph node metastases.
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Affiliation(s)
- Manel Njima
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Bahaeddine Lahbacha
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Sadok Ben Jabra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Amani Moussa
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Ahlem Bellalah
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Nouha Ben Abdeljelil
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Seifeddine Ben Hammouda
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Leila Njim
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Rim Hadhri
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Abdelfattah Zakhama
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
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Su D, Yang H, Zhao M, Zhou H, Wu J, Zhao Z, Zhong J, Xue Q, Hong Y, Sun J, Li X, Zhao T. Malignant gastrointestinal neuroectodermal tumor: a case report and literature review. Ann Med Surg (Lond) 2023; 85:6196-6201. [PMID: 38098564 PMCID: PMC10718339 DOI: 10.1097/ms9.0000000000001400] [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: 09/05/2023] [Accepted: 10/06/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance A malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare primary malignant mesenchymal tumor of the gastrointestinal tract characterized by EWSR1 gene rearrangement. An optimal systemic treatment strategy for advanced/recurrent GNET has not yet been identified. Case presentation A 24-year-old male patient was hospitalized with abdominal pain and underwent two operations for a tumor in his small intestine. Immunohistochemistry (IHC) showed strong expression of S-100 protein and SOX 10. Fluorescence in situ hybridization analysis and next-generation sequencing analysis indicated that there were EWSR gene rearrangements and the presence of EWSR-ATP1 gene fusions, respectively. The diagnosis of GNET in the small intestine was confirmed by pathology. The young patient received the fifth-line of apatinib mesylate and the sixth-line of apatinib combined with temozolomide. The two apatinib-containing regimens showed stable disease and progression-free survival of 4.7 months and 3.1 months with single-agent apatinib or apatinib combined with temozolomide, respectively. Clinical discussion To our best knowledge, this is the first report of malignant GNET treated with apatinib and temozolomide. Apatinib-containing regimens might has antineoplastic activity against GNET. The authors reviewed the relevant reports of previous GNET treatment, summarized the clinicopathological characteristics of GNET, and found that there are no reports of apatinib for backline treatment of GNET. Conclusion Containing apatinib may provide an additional treatment option for patients with chemotherapy-resistant GNET tumors.
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Affiliation(s)
- Dan Su
- Department of Clinical Medicine, Hangzhou Medical College
| | - Hujuan Yang
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui
| | | | - Hongying Zhou
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
| | - Jin Wu
- Department of Medical Oncology, Chun’an First People’s Hospital
| | - Zhongkuo Zhao
- General Surgery Department, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | | | - Qian Xue
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
| | - Yupeng Hong
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
| | - Jie Sun
- Department of Respiratory and Critical Care Medicine, Shidong Hospital, Yangpu District, Shanghai, People’s Republic of China
| | - Xiaoyi Li
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui
| | - Tongwei Zhao
- Department of Medical Oncology, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College)
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui
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Kandler T, Cortez E, Clinton L, Hemmerich A, Ahmed O, Wong R, Forns T, MacNeill AJ, Hamilton TD, Khorasani M, Feng X. A Case Series of Metastatic Malignant Gastrointestinal Neuroectodermal Tumors and Comprehensive Genomic Profiling Analysis of 20 Cases. Curr Oncol 2022; 29:1279-1297. [PMID: 35200608 PMCID: PMC8870546 DOI: 10.3390/curroncol29020109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 12/23/2022] Open
Abstract
Malignant gastrointestinal neuroectodermal tumor (GNET) is an ultra-rare soft tissue sarcoma, therefore often misdiagnosed and has no available standard treatment. Here, we report 3 cases of metastatic GNET with variable clinical courses. Our small case series as well as extensive literature review, further support that GNET is a spectrum of diseases with variable inherent biology and prognosis. Surgical management in the setting of recurrent/metastatic disease may be appropriate for GNET with indolent nature. Response to systemic treatments including chemotherapy and targeted treatments is variable, likely related to heterogenous biology as well. Furthermore, we retrospectively identified 20 additional GNET cases from Foundation Medicine’s genomic database and expanded on their clinicopathological and genomic features. Comprehensive genomic profiling (CGP) with DNA and RNA sequencing of this cohort, in the course of clinical care, demonstrated recurrent EWSR1 chromosomal rearrangements and a sparsity of additional recurrent or driver genomic alterations. All cases had low tumor mutational burden (TMB) and were microsatellite stable.
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Affiliation(s)
- Taylor Kandler
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Eliane Cortez
- Foundation Medicine, Inc., Cambridge, MA 02141, USA;
| | - Lani Clinton
- Foundation Medicine, Inc., Morrisville, NC 27560, USA; (L.C.); (A.H.)
| | - Amanda Hemmerich
- Foundation Medicine, Inc., Morrisville, NC 27560, USA; (L.C.); (A.H.)
| | - Osama Ahmed
- Department of Medical Oncology, Saskatoon Cancer Center, Saskatoon, SK S7N 4H4, Canada;
| | - Ralph Wong
- Department of Medical Oncology, Cancer Care Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Taylor Forns
- Department of Pathology, Duke University, Durham, NC 27710, USA;
| | - Andrea J. MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.J.M.); (T.D.H.); (M.K.)
| | - Trevor D. Hamilton
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.J.M.); (T.D.H.); (M.K.)
| | - Mohammadali Khorasani
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.J.M.); (T.D.H.); (M.K.)
| | - Xiaolan Feng
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Correspondence:
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Chen C, Yin W, Wang X, Li P, Chen Y, Jin X, Yang P, Wu H. Synchronous Malignant Gastrointestinal Neuroectodermal Tumor and SMARCA4-Deficient Undifferentiated Carcinoma With Independent Origins in the Small Intestine: A Case Report. Front Oncol 2021; 11:665056. [PMID: 34513665 PMCID: PMC8429901 DOI: 10.3389/fonc.2021.665056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 01/14/2023] Open
Abstract
Background Malignant gastrointestinal neuroectodermal tumor (GNET) is a rare malignant mesenchymal neoplasm that commonly arises in the small bowel, stomach or colon. Meanwhile, SMARCA4-deficient undifferentiated carcinoma is a rarely reported entity with highly aggressive behavior that may involve the ovary, lung, gastrointestinal (GI) tract, endometrium and other organs. To our knowledge, we describe for the first time, an extremely rare case of synchronous GNET and SMARCA4-deficient undifferentiated carcinoma with independent origins in the small intestine. Case Presentation A 46-year-old woman presented with multiple small intestine masses and underwent surgical resection. Two distinct entities, GNET and SMARCA4-deficient undifferentiated carcinoma, were identified. GNET was composed of epithelioid and spindle cells with clear or eosinophilic cytoplasm arranged in sheets, nest, papillary, fascicular, palisade, rosette like or pseudoalveolar pattern. The neoplastic cells were positive for S-100 and SOX-10. Ewing sarcoma breakpoint region 1 gene (EWSR1) rearrangement was confirmed by fluorescence in situ hybridization (FISH), and EWSR1-CREB1 fusion was revealed by next-generation sequencing (NGS). SMARCA4-deficient undifferentiated carcinoma was composed mainly of poorly adhesive rhabdoid cells with eosinophilic cytoplasm arranged in a diffuse pattern. Multifocal necrosis, brisk mitotic figures as well as multinucleated tumor cells were observed. The neoplastic cells diffusely expressed pancytokeratin and vimentin, and was negative for SMARCA4(BRG1). Frame shift mutation of SMARCA4 was detected by NGS. Conclusions This is the first report that GNET and SMARCA4-deficient undifferentiated carcinoma occurred simultaneously in the small intestine, with the latter showing multiple involvement of the jejunum and ileum. The potential mechanism underlying co-existence of these two rare malignancies is unknown and need further investigations and concern.
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Affiliation(s)
- Cuimin Chen
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Weihua Yin
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Xingen Wang
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Ping Li
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Yaoli Chen
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Xianglan Jin
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Ping Yang
- Department of Pathology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Peking, China
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