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Al-Mohammad A, Dyson EW, Russo VM, Russo A. Drop metastasis from the extradural to the intradural space in spinal Ewing's sarcoma - a novel case report. Br J Neurosurg 2023:1-4. [PMID: 37723663 DOI: 10.1080/02688697.2023.2258205] [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: 04/03/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
Spinal Ewing's Sarcoma is a rare tumour predominantly affecting children and adolescents. We describe the case of an 18-year-old male patient who first presented with a primary extradural cervical Ewing's sarcoma tumour, and 5 years later had a recurrence with thoracolumbar and lumbosacral intradural extramedullary Ewing's sarcoma tumours. Both presentations were successfully treated by surgical resection and adjuvant chemo- and radiotherapy, and he remains disease-free at 12 months follow-up. This is the first reported case of seeding of tumour from an extradural primary Ewing's sarcoma to intradural metastases. Total surgical resection of his initial cervical tumour, performed at another centre, was complicated by a dural tear and CSF leak. Thus, we propose that isolated drop metastasis via CSF fistula is the most likely mechanism for tumour spread in this case. Thus, clinicians may wish to counsel patients on the possibility of such spread if a CSF leak is encountered, and potentially increase the frequency of imaging surveillance of the whole spine in this context.
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Affiliation(s)
- Alaa Al-Mohammad
- The Victor Horsley Department of Neurosurgery, The Hospital for Neurology and Neurosurgery, London, UK
| | - Edward W Dyson
- The Victor Horsley Department of Neurosurgery, The Hospital for Neurology and Neurosurgery, London, UK
| | - Vittorio M Russo
- The Victor Horsley Department of Neurosurgery, The Hospital for Neurology and Neurosurgery, London, UK
| | - Antonino Russo
- The Victor Horsley Department of Neurosurgery, The Hospital for Neurology and Neurosurgery, London, UK
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2
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Heller D, Wasilewski G, Mustafa J, Chaudhry H, Lowery E, Borys D, Allam E. Extraskeletal Ewing sarcoma of the sciatic nerve. Radiol Case Rep 2023; 18:1221-1226. [PMID: 36660563 PMCID: PMC9842801 DOI: 10.1016/j.radcr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare tumor diagnosed in children or young adults and is even more unusual in individuals over 30 years of age. Due to its rare occurrence and low index of suspicion, this tumor can pose diagnostic and therapeutic challenges. We present a case of a 60-year-old male with EES of the sciatic nerve, an unexpected entity given the patient's age, tumor type, and tumor location. This can mimic a nerve sheath tumor on imaging.
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3
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Zhang GH, Lin JM, He ZY, Yuan XJ, Li G, Gan XR, Xu WH, Cao SS. A case of giant Ewing's sarcoma (EES)/primitive neuroectodermal tumor (PNET) of the cervicothoracic junction in children with incomplete paralysis of both lower limbs: Case report and literature review. Front Surg 2023; 9:1066304. [PMID: 36684168 PMCID: PMC9852823 DOI: 10.3389/fsurg.2022.1066304] [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] [Received: 10/10/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background Extraosseous Ewing's sarcoma/primary neuroectodermal tumor (EES/PNET) is a rare, malignant, small round blue cell tumor, which usually involves the larynx, kidneys, and esophagus. The most common metastatic sites are lung and bone. The incidence of epidural EES/PNET was 0.9%, and a detailed search of the PubMed literature found only 7 case reports of epidural ESS/PNET at the cervicothoracic junction in children. Case description We report a case of epidural ESS/PNET at the cervicothoracic junction in a child with chest and back pain as the first symptom, which worsened after half a year and developed incomplete paralysis of both lower extremities and urinary incontinence. She underwent emergency surgery, chemotherapy and radiotherapy, and died of lung metastases 8 months after surgery. Conclusion Primary epidural tumors are mostly benign, such as spinal meningiomas and neuromas. Contrary to what has been previously thought, we report a case of malignant epidural EES/PNET at the cervicothoracic junction without bone destruction; The rarity of epidural EES/PNET at the cervicothoracic junction in children has led to a lack of data, particularly on prognostic factors and recurrence patterns. Due to the difficulty of early diagnosis and high mortality, spine surgeons must explore and increase their awareness of this disease.
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4
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Ebrahimi R, sohi ASM, Mirsardoo A, Moosavi N, Khonji MS. Primary intradural extramedullary Ewing sarcoma in the lumbar area: A case report. Radiol Case Rep 2022; 17:4617-4621. [PMID: 36204406 PMCID: PMC9530492 DOI: 10.1016/j.radcr.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022] Open
Abstract
Primary intradural extramedullary Ewing sarcoma (IEES) is the rarest type of Ewing sarcoma. Extreme caution is required for the diagnosis of IEES because benign intradural spinal tumors can be mistaken for IEES in the early stages of imaging and clinical evaluation. IEES tumors have no standardized treatment guidelines because of the lack of research on the therapeutic aspects of these tumors. Herein, we present a case of primary IEES in a male adolescent with a fast progression of the disease. Diagnosis of IEES was suspected with imaging (computed tomography scan and lumbosacral magnetic resonance imaging) and was confirmed with histology and immunohistochemistry (positive reactivity for CD99 and FLI1). He was successfully treated with surgical intervention with no radiotherapy or chemotherapy. Imaging studies are helpful in making the initial diagnosis of intradural extramedullary Ewing sarcoma. Surgery is considered to be a successful method of treatment for this condition.
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Mousavi SR, Farrokhi MR, Eghbal K, Dehghanian A, Rezvani A, Ghaffarpasand F. Metastatic thoracic and lumbar intramedullary and extramedullary Ewing's sarcoma: a rare case report and literature review. J Int Med Res 2022; 50:3000605221108095. [PMID: 35938475 PMCID: PMC9364211 DOI: 10.1177/03000605221108095] [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] [Indexed: 11/17/2022] Open
Abstract
Ewing sarcoma (ES) is a highly aggressive bone and soft tissue tumor that occurs
mainly in young children and adolescents and is associated with primary and
metastatic disease. Intramedullary ES (either primary or secondary) is rare, and
the ideal management remains inconclusive. We herein report intramedullary and
extramedullary metastatic ES in a single patient. A 46-year-old woman was
referred to our outpatient clinic from the oncology clinic with progressive
paraparesis and paresthesia for 1 week prior to presentation. She had developed
left clavicular ES 2 years earlier for which surgery and chemoradiotherapy had
been performed. At the present evaluation, she was diagnosed with intramedullary
thoracic and lumbar extradural masses. Thoracic surgery was performed, and a
biopsy of the lesion was obtained. The diagnosis of ES was confirmed
histopathologically, and she underwent adjuvant chemotherapy. Her neurological
status did not improve after surgery, and she underwent rehabilitation and
physical therapy. The lumbar lesion resolved with chemotherapy. Metastasis of ES
to the spinal cord, especially intramedullary lesions, is extremely rare, and
there is no standard management guideline. However, surgical decompression and
adjuvant chemotherapy are the main treatments in these cases.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Trauma research center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Carballo Cuello CM, De Jesus O, de Jesús Espinosa A, Fernández-de Thomas RJ, Murray G, Pastrana EA. Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review. Cureus 2022; 14:e26665. [PMID: 35959190 PMCID: PMC9360665 DOI: 10.7759/cureus.26665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 01/08/2023] Open
Abstract
Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.
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7
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Hong B, Li Y, Yang R, Dai S, Zhan Y, Zhang WB, Dong R. Single-cell transcriptional profiling reveals heterogeneity and developmental trajectories of Ewing sarcoma. J Cancer Res Clin Oncol 2022; 148:3267-3280. [PMID: 35713707 DOI: 10.1007/s00432-022-04073-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Ewing sarcoma (EwS) is an aggressive malignant neoplasm composed of small round cells. The heterogeneity and developmental trajectories of EwS are uncertain. METHODS Single-cell RNA sequencing was performed on 4 EwS tumor tissue samples, and 3 transcriptional atlases were generated. K-nearest neighbor algorithm was used to predict the origin of tumor cells at single-cell resolution. Monocle2 package was used to perform pseudotime trajectory analysis in tumor cells. Differentially expressed genes were compared against those in all other clusters via the FindMarkers function, and then they were subjected to GO analysis using clusterProfiler package. RESULTS Combined with the results of k-nearest neighbor algorithm and pseudotime trajectory analysis in tumor cells, we thought meningeal EwS originated from neural crest cells during epithelial to mesenchymal transition and simulated the process of neural crest cell lineage differentiation. But for perirenal EwS and spinal EwS, we hypothesized that after the neural crest cell lineage mutated into them, the tumor cells did not maintain the differentiation trajectory of neural crest cell lineage, and the development trajectory of tumor cells became chaotic. GO analysis results showed that interferon signaling pathway-related biological processes play an essential role in the tumorigenesis and tumor progression process of EwS, and among these biological processes genes, JAK1 gene up-regulated most significantly and highly expressed in all tumor cells. Ruxolitinib was used to explore the function of JAK1. Targeting JAK1 can promote apoptosis of EwS tumor cells, inhibit the migration and invasion of EwS tumor cells, and inhibit cell proliferation by inducing cell cycle S phase arrest. CONCLUSION EwS was derived from neural crest cell lineage with variable developmental timing of oncogenic conversion, and the JAK1 might be a candidate for therapeutic targets of EwS.
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Affiliation(s)
- Bo Hong
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yi Li
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ran Yang
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - ShuYang Dai
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yong Zhan
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Wen-Bo Zhang
- Department of Pediatric Thoracic Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
| | - Rui Dong
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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The Role of Neuroaxis Irradiation in the Treatment of Intraspinal Ewing Sarcoma: A Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14051209. [PMID: 35267515 PMCID: PMC8909708 DOI: 10.3390/cancers14051209] [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: 12/31/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
The role of cranio-spinal irradiation (CSI) for primary extraosseous intraspinal Ewing sarcoma (EwS) remains unclear. Here, we evaluate clinical and survival outcomes in patients with primary intraspinal EwS treated with CSI as part of multimodal primary therapy regimens. We abstracted patient information, including details on treatment application, efficacy, and tolerance from the literature and our hospital database for a cohort of 24 primary intraspinal EwS patients treated with CSI. Median age was 25.5 years, median CSI dose was 36 Gy and mean boost dose was 12.8 Gy. Sixteen patients (66.7%) achieved complete radiological remission, another 5 patients demonstrated partial response and 1 patient showed no response to treatment. Compared to a cohort of patients treated with focal radiotherapy, CSI patients were more likely to have multifocal disease at time of diagnosis (p = 0.001) and intradural tumor location (p < 0.001). Despite over-representation of these unfavorable characteristics, there was no survival difference between groups (p = 0.58). While CSI shows promising results in the treatment of primary intraspinal EwS, treatment should be considered individually based on tumor and patient characteristics in the absence of prospective trials.
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9
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Primary extra-skeletal Ewing's sarcoma presenting as an epidural Soft Tissue Lesion causing cauda equina syndrome in an adolescent girl: a case report. Spinal Cord Ser Cases 2022; 8:13. [PMID: 35075107 PMCID: PMC8786895 DOI: 10.1038/s41394-021-00474-7] [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: 06/15/2021] [Revised: 11/05/2021] [Accepted: 12/29/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Primary epidural Ewing's sarcoma in the lumbar spinal canal is a rare condition and very few cases are reported in the literature. CASE REPORT A fifteen-year-old girl presented with low backache associated with sudden onset of weakness and radiculopathy of both lower limbs for 10 days, bowel and bladder involvement for 3 days. Physical examination revealed grade 0/5 power and absent sensations below L4 dermatomal level and perianal region (ASIA A). Plantar reflex was mute bilaterally. Magnetic resonance imaging revealed an extradural lesion within the spinal canal at the L3-L4 level. The patient underwent an emergency posterior decompression, extradural lesion excision and instrumented stabilization L3-L5. Based on histopathological examination of the tissue specimen, we diagnosed the lesion as Ewing sarcoma. DISCUSSION Primary extra-skeletal Ewing's sarcoma presenting as an epidural lesion in the lumbar spine is a rare clinical entity that should be considered as a differential for spinal epidural lesions. Treatment for such cases is almost always an early surgical intervention due to its rapid onset and compressive neurological symptoms. Wide decompression with instrumented fusion and excision of the lesion followed by chemo and radiotherapy are recommended.
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10
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Wang J, Li J, Zhang X, Zhang X, Xiao Y. Primitive neuroectodermal tumor of the pericardium: a case report and literature review. BMC Cardiovasc Disord 2021; 21:305. [PMID: 34134636 PMCID: PMC8207573 DOI: 10.1186/s12872-021-02113-3] [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: 03/08/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background The primitive neuroectodermal tumors (PNETs) are a family of highly malignant tumors with a multidirectional differential potential. The tumors are characterized by aggressive small round tumor cells that originate from the spinal cord of the central and sympathetic nervous systems. Cases involving the pericardium are extremely rare. Herein, we present a case of peripheral primitive neuroectodermal tumor (pPNET) that originated in the pericardium. Case presentation A 23-year-old woman presented with cough and progressive dyspnea for 1 month, followed by eyelid and facial edema for 10 days, without any apparent cause. Significantly elevated tumor markers were detected in her blood. A cardiac ultrasound revealed a 74 mm × 61 mm spherical mass that was attached to the left pericardium, as well as massive pericardial effusion. Positron emission tomography-CT (PET-CT) showed focal hypermetabolism in the left pericardium. Via histopathology and immunohistochemistry, the spherical mass was identified as PNETS. The patient was successfully treated with a combination of surgical resection via thoracotomy and postoperative chemotherapy, and she was disease-free for 7 years at follow-up. Unfortunately, at 7 years after the treatment, the patient’s pPNET recurred. Positron emission tomography-MRI (PET-MRI) and 64-slice coronary CTA revealed that the aorta and multiple coronary arteries were involved. Subsequently, the patient refused a heart transplant and voluntarily left the hospital. Conclusions This paper reports on a rare and recurrent case of PNET in the parietal pericardium. With respect to the different biologic characteristics and prognoses of pPNETs (compared to other known pericardium tumors), it is essential to consider this entity as a differential diagnosis in pericardium tumors.
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Affiliation(s)
- Jingjing Wang
- Department of Intensive Care Unit, Tianjin First Center Hospital, No.24 Fukang Street of Nankai District, Tianjin, 300152, China.
| | - Jing Li
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Street of Haidian District, Beijing, 100853, China.,Department of MRI, Affiliated Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, 300162, China
| | - Xiao Zhang
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Street of Haidian District, Beijing, 100853, China
| | - Xiaobo Zhang
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Street of Haidian District, Beijing, 100853, China
| | - Yueyong Xiao
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Street of Haidian District, Beijing, 100853, China
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11
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Patil AS, Gupta PP, Iratwar SW. Primary Spinal Extradural Extraosseous Primitive Neuroectodermal Tumor/Ewing's Sarcoma: A Critical Analysis and Review. Asian J Neurosurg 2021; 16:276-280. [PMID: 34268151 PMCID: PMC8244703 DOI: 10.4103/ajns.ajns_340_20] [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: 07/12/2020] [Revised: 10/08/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022] Open
Abstract
Primary spinal extradural Ewing's sarcoma/primitive neuroectodermal tumor (PNET) is rare malignant tumor of childhood and early adulthood. The World Health Organization classifies PNET as an undifferentiated round cell tumor arising from primitive neuroepithelial cell. It can be central or peripheral PNET depending on site of presentation. Usually, the presenting symptoms are chronic back pain and myelopathy. Overall prognosis and survival are dismal in spite of total surgical resection and adjuvant therapy. Because of the rarity and malignant behavior, definite management of spinal PNET has never been described. After review of medical record at Acharaya Vinoba Bhave Rural Hospital, Sawangi, India, we identified four patients of spinal PNET and were included in our study. Age at diagnosis ranging from 15 to 26 years old with mean age of 20 years old. All four cases were epidural in location, two of which were of Askin type tumor with spinal cord compression. Rural population with low literacy and financial constraints were the key reasons of late presentations at our hospital. Counseling and proper education regarding the disease are a must for early case detection and early treatment of those living in rural areas and suffers from financial constraints. Due to rarity of the disease and its poor prognosis, a well-organized multicentric controlled trial is required to formulate a standard guidelines in the management of this disease.
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12
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Wei X, Zhang X, Song Z, Wang F. Analysis of Clinical, Imaging, and Pathologic Features of 36 Patients with Primary Intraspinal Primitive Neuroectodermal Tumors: A Case Series and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2021; 82:526-537. [PMID: 33845511 DOI: 10.1055/s-0041-1723810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. MATERIALS AND METHODS We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. RESULTS The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1-60 years), and patients <36 years of age accounted for 83.30% of the study cohort. Progressive limb weakness and numbness were the chief symptoms (accounting for ∼55.6%). The mean complaint duration was 0.89 ± 0.66 months for males and 2.72 ± 3.82 months for females (p = 0.028). Epidural (41.7%) was the most common site, and thoracic (47.3%) was the most frequent location. Most PNETs were peripheral, and magnetic resonance imaging (MRI) appearance was isointense or mildly hypointense on T1-weighted images and hyperintense on T2-weighted images. Homogeneous contrast enhancement was observed. The 1-year survival rate of patients who underwent chemoradiation after total or subtotal lesion resection was better compared with patients who did not undergo chemotherapy, radiotherapy, or total or subtotal resection. The modality of treatment was associated with survival time (p = 0.007). CONCLUSION Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.
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Affiliation(s)
- Xuefeng Wei
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, Republic of China
| | - Xu Zhang
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, Republic of China
| | - Zimu Song
- Department of Neurosurgery, General Hospital Of NingXia Medical University, Yinchuan, Republic of China
| | - Feng Wang
- Department of Neurosurgery, General Hospital Of NingXia Medical University, Yinchuan, Republic of China.,Ningxia Key Laboratory of Cerebrocranial Diseases, Ningxia Medical University, Yinchuan, Republic of China
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13
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Tiwari S, Yadav T, Pamnani J, Shukla K, Rao M, Gosal JS, Garg P, Khera PS. Primary Spinal Epidural Extraosseous Ewing's Sarcoma with Brachial Plexus Infiltration. Asian J Neurosurg 2020; 15:1068-1071. [PMID: 33708691 PMCID: PMC7869268 DOI: 10.4103/ajns.ajns_138_20] [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: 04/05/2020] [Revised: 07/01/2020] [Accepted: 09/03/2020] [Indexed: 11/11/2022] Open
Abstract
The Ewing's sarcoma family of tumors are aggressive malignant small round blue cell tumors of undifferentiated mesenchymal origin. Skeletal Ewing's sarcoma is a common entity that classically involves the diaphysis of the long bones, pelvis, ribs, and sacrum. Extraosseous Ewing's sarcoma (EES) is rare, most commonly presenting as a paravertebral mass lesion. Its manifestation as an anterior epidural mass lesion with extension along brachial plexus is an even rarer phenomenon. A 25-year-old male presented with neck stiffness and progressive weakness of the bilateral upper and lower limbs. Magnetic resonance imaging of the cervical spine revealed an anterior epidural mass lesion compressing the cervical cord and extending along the right brachial plexus, suggesting imaging differentials of EES and lymphoma. The patient underwent laminectomy with gross tumor resection, and histopathology confirmed a diagnosis of EES. EES should be kept in the differential diagnosis of anterior epidural mass lesions in young adults, specifically when the lesion shows extension along multiple neural foramina and nerve plexus.
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Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaya Pamnani
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kartikeya Shukla
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Meenakshi Rao
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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14
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Liu Y, Yuan Y, Zhang F, Hu K, Qiu J, Hou X, Yan J, Lian X, Sun S, Liu Z, Shen J. Outcome of multidisciplinary treatment of peripheral primitive neuroectodermal tumor. Sci Rep 2020; 10:15656. [PMID: 32973274 PMCID: PMC7519088 DOI: 10.1038/s41598-020-72680-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 09/01/2020] [Indexed: 11/26/2022] Open
Abstract
Peripheral primitive neuroectodermal tumors (PNETs) constitute very rare and aggressive malignancies. To date, there are no standard guidelines for management of peripheral PNETs due to the paucity of cases arising in various body sites. Therapeutic approach is derived from Ewing sarcoma family, which currently remains multimodal. Our study retrospectively analyzed 86 PNET patients from February 1, 1998 to February 1, 2018 at Peking Union Medical College Hospital with an additional 75 patients from review of literature. The clinicopathologic and treatment plans associated with survival was investigated. Surgery, chemotherapy, female sex, small tumor size, no lymph node metastasis, R0 surgical resection, (vincristine + doxorubicin + cyclophosphamide)/(isophosphamide + etoposide) regimen, and more than 10 cycles of chemotherapy were associated with improved overall survival in univariate analysis. Surgery, more than 10 cycles of chemotherapy, and small tumor size were independent prognostic factors for higher overall survival. Our data indicates that multimodal therapy is the mainstay therapeutic approach for peripheral PNET.
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Affiliation(s)
- Yidi Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yan Yuan
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jie Qiu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jie Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
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15
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Ganapathy S, Subramaniam V, Baliga V. Spinal Ewing's Sarcoma Presenting as an Epidural Collection: A Rare Presentation of a Rare Entity. Asian J Neurosurg 2020; 15:445-448. [PMID: 32656151 PMCID: PMC7335116 DOI: 10.4103/ajns.ajns_371_19] [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: 12/28/2019] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
Rare entities are difficult to predict. They are considered last rightly, to expedite treatment and alleviate symptoms quickly. Rare presentations of rare diseases form a particularly difficult section of diagnoses that are not only impossible to predict but difficult to recognize, diagnose, and treat. Often the dilemma is to, investigate thoroughly saving time but financially burdening the patient and hospital, or, to investigate in gradual increments taking more time and effort, especially in rare cases where prolonged hospitalization and suffering occurs before the diagnosis is reached. This approach, however, wastes critically important time, which, especially in neurological compression, may often lead to irreversible deficits. This dilemma is admirably demonstrated in this case report of spinal Ewing's sarcoma. A young female presented to us with recurrent high cervical epidural collections presenting as compressive myelopathy. She underwent repeated decompressions, and the collection was misdiagnosed as tuberculosis, which was treated without empirical evidence, leading to significant irreversible disability. Finally, when she came to us, the histopathological assessment was done to reveal the diagnosis. Ewing's sarcomas, and indeed the whole gamut of small-round-cell malignancies, are great imitators. They are known to exist in the skull base mimicking schwannomas, chordomas, germinomas, pituitary adenomas, and even epidermoids and occasionally extend to the vertebral bodies and the cranio-vertebral Junction (CVJ) leading to instability and neurological compression. Here, they mimic vertebral tumors, discitis, infective abscesses, and even myeloma. Predictably, such an entity is diagnosed last, and diagnosed late, leading to bad consequences for the patient. Such was the fate of our patient. The report emphasizes the diagnostic dilemma and presents the need to use protocols for diagnosis and treatment, even in rare cases, to effect the best possible outcomes for patients. The use of a thorough diagnostic and management algorhythm prevents deeper and sinister disease processes from being missed.
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Affiliation(s)
- Sibhi Ganapathy
- Department of Neurosurgery, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Venugopal Subramaniam
- Department of Neurosurgery, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Vidya Baliga
- Department of Pathology, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
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16
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Han MS, Lee SK, Moon BJ, Lee JK, Choi YD. Primary Extraosseous Ewing Sarcoma of the Thoracic Spine Presenting as Chest Pain Mimicking Spinal Schwannoma. World Neurosurg 2020; 141:507-510. [PMID: 32445898 DOI: 10.1016/j.wneu.2020.05.130] [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: 04/01/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extraosseous Ewing sarcoma (EES) usually has a pseudocapsule and high vascularity, making it well circumscribed and focally dense with contrast enhancement on magnetic resonance imaging (MRI). Consequently, it is difficult to diagnose and distinguish from other spinal tumors, based on pretreatment radiologic findings alone. Here, we present a case of EES involving the thoracic spinal column, which was suspected to be spinal schwannoma through pretreatment radiologic findings. CASE DESCRIPTION A 54-year-old woman was admitted to our hospital with upper back and left-sided chest pain. Contrast-enhanced MRI of the thoracolumbar spine showed a 17- × 12-mm-sized mass in the epidural region and left neural foramen at the T6-7 level. Our preliminary diagnosis was spinal schwannoma. The patient underwent T6 hemilaminectomy. Intraoperatively, the lesion appeared as gray-colored soft mass with high vascularity, which seemed to have originated from the left T6 nerve root. The tumor was excised with en bloc resection. Histopathologic examination of the lesion revealed classical Ewing sarcoma with high cellularity of small round cells. Immunohistochemistry revealed strong positivity for cluster of differentiation 99 and FLI-1. Intensity-modulated radiation therapy was performed. The patient did not receive chemotherapy. Five years after surgery, follow-up spinal MRI and positron emission tomography computed tomography scan revealed no recurrence of the tumor or new lesions. CONCLUSIONS Clinicians should consider EES in the differential diagnosis of other neural foraminal spinal tumors, such as schwannoma. If clinicians are confident that EES has been removed completely and there are no other lesions, radiotherapy is sufficient and additional chemotherapy may not be necessary.
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Affiliation(s)
- Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Seul-Kee Lee
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Bong Ju Moon
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea.
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School & Research Institute of Medical Sciences, Gwangju, Korea
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17
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Schartz D, Divakar P, Tafe L, Paydarfar J. Primary Ewing's sarcoma of the petroclival bone: A case report and literature review. Surg Neurol Int 2020; 11:6. [PMID: 31966925 PMCID: PMC6969381 DOI: 10.25259/sni_415_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/19/2019] [Indexed: 11/09/2022] Open
Abstract
Background: Primary Ewing’s sarcoma (ES) is typically seen within the long bones, vertebrae, or pelvis. Uncommonly, it can be found within the cranium among the rarest locations for primary ES are the skull base, in particular, the petroclival bone. Case Description: The patient is a 68-year-old female with past medical history of Stage III breast cancer who presented with severe retro-orbital headache and diplopia due to a cranial nerve VI palsy. Magnetic resonance imaging (MRI) revealed a mass at the left petroclival bone with extension into the adjacent left petrous apex and into the posterior aspect of the left cavernous sinus proximal to the carotid artery. The patient subsequently underwent an endoscopic transsphenoidal biopsy. Pathological and molecular analysis supported a diagnosis of ES. The patient then underwent neoadjuvant chemotherapy and radiotherapy. At 12 month-follow-up, her petroclival ES demonstrated significant interval decrease in size on MRI surveillance imaging. Conclusions: This is the third case of primary ES of the petroclival bone to be reported in the literature. In this patient, management consisted of surgical incisional biopsy followed by adjuvant radiation and chemotherapy. Knowledge and awareness of this type of tumor is important for the skull base surgeon.
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Affiliation(s)
- Derrek Schartz
- Department of Surgery, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | | | - Laura Tafe
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph Paydarfar
- Department of Surgery, Section of Otolaryngology- Head and Neck Surgery
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18
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Primary Spinal Epidural/Extramedullary Ewing Sarcoma in Young Female Patients. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:JAAOSGlobal-D-19-00072. [PMID: 31875190 PMCID: PMC6903810 DOI: 10.5435/jaaosglobal-d-19-00072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary spinal epidural/extramedullary ewing sarcoma (ES) is a rare extraosseous lesion. Extraosseous ES has a similar demographic as osseous ES, primarily affecting adolescents and young adults and male propensity. Reported 5-year survival is 0% to 37.5% for spinal extraosseous ES.
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19
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Chen J, Li M, Zheng Y, Zheng L, Fan F, Wang Y. Treatment Outcomes and Prognostic Factors of Patients With Primary Spinal Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumors. Front Oncol 2019; 9:555. [PMID: 31293980 PMCID: PMC6603090 DOI: 10.3389/fonc.2019.00555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose: Primary spinal Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare, and the current understanding of these tumors is poor. The authors aimed to illustrate the clinical characteristics of primary spinal ES/pPNETs and to discuss prognostic factors by survival analysis. Methods: A total of 40 patients who were pathologically diagnosed with primary spinal ES/pPNETs between 2000 and 2018 were enrolled in this study. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method to identify potential prognostic factors. Factors of p ≤ 0.1 in the Log-rank tests were subjected to multivariate analysis by Cox regression analysis. Results: The mean follow-up period was 23.8 (range, 2–93) months, and 24 (60.0%) patients had local recurrence and 11 (27.5%) patients had distant metastasis. The 1-, 2-, and 5-year PFS rates were 57.7, 30.4, and 9.5%, respectively. The 1-, 2-, and 5-year OS rates were 74.8, 50.7, and 12.2%, respectively. The univariate analysis suggested that resection mode, postoperative Frankel score, adjuvant chemotherapy and adjuvant radiotherapy were potential prognostic factors for OS and PFS. However, after these factors were subjected to multivariate analyses, only adjuvant radiotherapy and resection mode remained as independent prognostic factors. Conclusions: Total en bloc resection can significantly improve PFS for primary spinal ES/pPNETs and adjuvant radiotherapy was a favorable factor for PFS. Total en bloc resection and adjuvant radiotherapy considerably improve OS for patients with primary spinal ES/pPNETs.
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Affiliation(s)
- Jun Chen
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengxue Li
- Department of Ultrasonics, The 991th Hospital of the Joint Logistics Support Unit of the Chinese People's Liberation Army, Xiangyang, China
| | - Yifeng Zheng
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zheng
- Department of Orthopedics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Fanfan Fan
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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20
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Tan CH, Tan D, Phung TB, Lai LT. Primary intradural extramedullary Ewing sarcoma of the cervical spine: A case report and review of the literature. J Clin Neurosci 2019; 66:280-284. [PMID: 31113698 DOI: 10.1016/j.jocn.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/19/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
Spinal intradural Ewing sarcoma (ES) of the cervical region is not common. Few cases have been reported and optimal management remain poorly defined. We described a case of a young woman with extensive primary leptomeningeal spinal ES and conducted a review of the literature.
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Affiliation(s)
- Chi Hau Tan
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Darius Tan
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Teik Beng Phung
- Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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21
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Serarslan A, Gursel B, Meydan AD, Kartal I, Gun S, Ceyhan M, Ozbek Okumus N. Torasik Spinal Kanalın Primer Ekstradural Ekstraosseöz Ewing Sarkomu: Olgu Sunumu. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.329118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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22
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Lavorato A, Titolo P, Vincitorio F, Cofano F, Garbossa D. Intraneural Ewing Sarcoma of Fibular Nerve: Case Report, Radiologic Findings and Review of Literature. World Neurosurg 2019; 123:212-215. [DOI: 10.1016/j.wneu.2018.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/24/2022]
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23
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Berger GK, Nisson PL, James WS, Kaiser KN, Hurlbert RJ. Outcomes in different age groups with primary Ewing sarcoma of the spine: a systematic review of the literature. J Neurosurg Spine 2019; 30:664-673. [PMID: 30771777 DOI: 10.3171/2018.10.spine18795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Ewing sarcoma (ES) is among the most prevalent of bone sarcomas in young people. Less often, it presents as a primary lesion of the spine (5%-15% of patients with ES). METHODS A systematic literature search was performed, querying several scientific databases per PRISMA guidelines. Inclusion criteria specified all studies of patients with surgically treated ES located in the spine. Patient age was categorized into three groups: 0-13 years (age group 1), 14-20 years (age group 2), and > 21 (age group 3). RESULTS Eighteen studies were included, yielding 28 patients with ES of the spine. Sixty-seven percent of patients experienced a favorable outcome, with laminectomies representing the most common (46%) of surgical interventions. One-, 2-, and 5-year survival rates were 82% (n = 23), 75% (n = 21), and 57% (n = 16), respectively. Patients in age group 2 experienced the greatest mortality rate (75%) compared to age group 1 (9%) and age group 3 (22%). The calculated relative risk score indicated patients in age group 2 were 7.5 times more likely to die than other age groups combined (p = 0.02). CONCLUSIONS Primary ES of the spine is a rare, debilitating disease in which the role of surgery and its impact on one's quality of life and independence status has not been well described. This study found the majority of patients experienced a favorable outcome with respect to independence status following surgery and adjunctive treatment. An increased risk of recurrence and death was also present among the adolescent age group (14-20 years).
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Affiliation(s)
- Garrett K Berger
- 1College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Whitney S James
- 3Division of Neurosurgery, High Desert Surgery Center, Prescott, Arizona
| | - Kristen N Kaiser
- 1College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - R John Hurlbert
- 4Division of Neurosurgery, University of Arizona, Tucson; and
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24
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Nery B, Pereira LCT, Costa RAF, Queiroz RM, Abud LG, Quaggio E, Coronatto LH, Prado IST, Miyake CH, Filho FB. Cervicomedullary primitive neuroectodermal tumor of the spine: Case report. Surg Neurol Int 2019; 9:241. [PMID: 30595962 PMCID: PMC6287338 DOI: 10.4103/sni.sni_41_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/23/2018] [Indexed: 11/04/2022] Open
Abstract
Background Intramedullary primitive neuroectodermal tumors (PNETs) are tumors found rarely in the cervical region, with only five such cases described in the literature. The available literature contains only one report regarding cervicomedullary junction PNET. Case Description The authors present a case report of a 45-year-old male patient who had undergone urgent hospitalization owing to progressive tetraparesis and subtle impairment of respiratory function. He underwent magnetic resonance imaging, which showed an extensive enhancing cervical intramedullary tumor extending from C5 to the bulbar region. Since he developed severe impairment of respiratory function, he required tracheostomy. He then underwent microsurgery 2 days after his admission, and a partial tumor resection was performed. The pathological diagnosis of PNET of the cervicomedullary junction (CMJ) was made. He had slight worsening of strength after surgery with subsequent deterioration over the next 3 weeks. The tumor displayed aggressive growth; thus, radiotherapy was indicated. Unfortunately, he developed severe febrile neutropenia and died after 2 weeks of radiotherapy. Given the rarity of the condition, we wish to review the epidemiology, pathophysiology, and treatment options of his population. Conclusion Intramedullary PNETs of the cervical spine and CMJ are exceedingly rare in adults; treatment of such patients remains a challenge, despite the modern neurosurgical armamentarium that is available.
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Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Lucas Giansante Abud
- Department of Radiology, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Quaggio
- Department of Neurosurgery, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Fred Bernardes Filho
- Department of Internal Medicine, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
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25
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Chen Z, Chen R, Ng C, Shi H. Primary pericardial primitive neuroectodermal tumor: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:2155-2159. [PMID: 31938326 PMCID: PMC6958199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/23/2018] [Indexed: 06/10/2023]
Abstract
Primitive neuroectodermal tumor (PNET) is a rare, high-grade malignant tumor that most commonly occurs in the peripheral nervous system, bone, and deep soft tissues. It is extremely rare in the pericardium. To the best of our knowledge, only two patients with primary PNET of the pericardium have been reported so far in the literature. We report a case of PNET of the pericardium in a 13-year-old female patient, who was referred to our hospital for dyspnea and edema of lower extremities. Computer tomography (CT) scanning revealed a soft tissue mass in the pericardium which was surgically removed. The diagnosis of PNET was confirmed by histology, immunohistochemistry and molecular study. The patient was alive and well at follow up 8 months after surgery.
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Affiliation(s)
- Zhenwei Chen
- Department of Pathology, Jinhua Municipal Central HospitalJinhua, Zhejiang Province, P. R. China
| | - Rongming Chen
- Department of Pathology, The People’s Hospital of Changfeng CountyChangfeng County, Anhui Province, P. R. China
| | - Chising Ng
- Department of Pathology St, Teresa’s HospitalKowloon, Hong Kong, P. R. China
| | - Hongqi Shi
- Department of Pathology, Jinhua Municipal Central HospitalJinhua, Zhejiang Province, P. R. China
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26
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Munjal S, Srivastava A, Tucker S, Bakshi N, Bhalla S, Mehta VS. Primary dorsal spine primitive neuroectodermal tumor in an adult patient: Case report and literature review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 8:378-381. [PMID: 29403254 PMCID: PMC5763599 DOI: 10.4103/jcvjs.jcvjs_70_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary spinal primitive neuroectodermal tumor (psPNET) is a rare entity with few cases reported in literature. We report a case of a 50-year-old female who presented to us with paraplegia and was diagnosed with extradural dorsal spine psPNET. The diagnosis was not suspected at presentation or on radiology but was established on histopathological examination. It is important to distinguish it from central nervous system primitive neuroectodermal tumors and from other spinal tumors since it follows a different clinical course and therapeutic outcome.
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Affiliation(s)
| | - Amit Srivastava
- Department of Neurosurgery, Paras Hospital, Gurgaon, Haryana, India
| | - Shivya Tucker
- Department of Radiology, Moolchand Medcity, New Delhi, India
| | - Neha Bakshi
- Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunita Bhalla
- Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - V S Mehta
- Department of Neurosurgery, Paras Hospital, Gurgaon, Haryana, India
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27
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Kutty RK, Peethambaran A, Sunilkumar BS, Balachandran Nair KG, Korde P, Jain SK. Ewing Sarcoma of the Cervical Epidural Space Presenting with Tetraplegia: Case Report and Review of Literature. World Neurosurg 2017; 107:1046.e9-1046.e15. [PMID: 28797979 DOI: 10.1016/j.wneu.2017.07.182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 07/27/2017] [Accepted: 07/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ewing sarcoma (ES) is among the most frequented extremity osseous tumor in childhood. It was first described by James Ewing as diffuse endotheliomas in 1921. The name Ewing sarcoma was coined by Oberling in 1928 as a tribute to the legend who described this disease. ES exists in osseous and extraosseous forms. It shares much of its molecular typing with primitive neuroectodermal tumor (PNET); hence, they are regarded as different ends of the same molecular spectrum. ES, extraosseous ES, PNET, and Askins tumor are the other members of this family termed the Ewing sarcoma family of tumors. Extraosseous ES has been described in various locations of the spine, but its occurrence in the cervical epidural region is uncommon. CASE DESCRIPTION A 12-year-old child presented to us with neck pain and progressive weakness of all 4 limbs. She was investigated and found to have a highly vascular lesion in the cervical epidural region extending from C2 to the C4 region. Embolization therapy was unsuccessful. She deteriorated and eventually had to undergo emergency surgery to decompress the spinal cord. The lesion was biopsied and diagnosed as extraosseous ES. After radiotherapy and chemotherapy, the patient regained most of the power in her limbs. CONCLUSION Extraosseous ES is a rare tumor of the cervical cord in this age group. We report this case to highlight the difficulties encountered in the management of this variant.
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Affiliation(s)
- Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India.
| | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | | | - Paresh Korde
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sourabh Kumar Jain
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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Amirjamshidi A. A case of early extraneural medulloblastoma metastases in a young adult. Asian J Neurosurg 2017; 12:349. [PMID: 28761505 PMCID: PMC5532912 DOI: 10.4103/1793-5482.175647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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29
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Kumar V, Singh A, Sharma V, Kumar M. Primary intracranial dural-based Ewing sarcoma/peripheral primitive neuroectodermal tumor mimicking a meningioma: A rare tumor with review of literature. Asian J Neurosurg 2017; 12:351-357. [PMID: 28761507 PMCID: PMC5532914 DOI: 10.4103/1793-5482.185060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) is a malignant small, round cell tumor arising from bone and soft tissue in children and young adults. It can occur at osseous and extraosseous sites. Its usual locations are diaphysis of long bones followed by pelvis, ribs, vertebrae, and rarely skull. We reviewed the literature and PubMed advanced search on ES/pPNET occurring at extraosseous sites, mainly involving the central nervous system (CNS). We reported a case of a 22-year-old male presenting with seizure finally diagnosed as a case of ES/pPNET. The challenges in management of this rare CNS tumor and its differential diagnosis are highlighted. We found that most cases of ES involving CNS represent secondary metastases from extracranial sites of ES/pPNET and there are rare case reports of primary intracranial ES-pPNET. Furthermore, among these intracranial tumors, most common tumors occupy an intraaxial location and only a handful of cases of dural-based or extraaxial tumors mimicking meningioma are reported. Differentiation of pPNET from central PNET (cPNET) is important as it has definitive therapeutic and prognostic implications. Awareness of this entity of ES/pPNET, its rare dural presentation, and differentiation from the more common cPNET is needed for appropriate patient management. Meningeal ES/pPNET has to be kept in mind in the differential diagnosis of meningeal tumors eroding bone.
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Affiliation(s)
- Vikul Kumar
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anshu Singh
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Sharma
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mohan Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Khmou M, Malihy A, Lamalmi N, Rouas L, Alhamany Z. Peripheral primitive neuroectodermal tumors of the spine: a case report and review of the literature. BMC Res Notes 2016; 9:438. [PMID: 27613377 PMCID: PMC5016941 DOI: 10.1186/s13104-016-2246-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/06/2016] [Indexed: 01/04/2023] Open
Abstract
Background Peripheral primitive neuroectodermal tumors are extremely rare tumors in the spine; only 18 cases of extra-dural peripheral primitive neuroectodermal tumor cervical region have been reported. The aim of this report is to highlight the challenges in diagnosis and management of this condition. Case presentation We present a case of 5-year-old Moroccan boy, who presented with torticollis for 1 month. Computed tomography scan and Magnetic resonance imaging of the cervical spine revealed an extradural, dumbbell-shaped mass with extra-spinal extension at the left C1–C6 level. Multiple biopsy specimens were obtained. Histological examination revealed a highly cellular neoplasm composed of diffuse sheets of tumor cells having monomorphic, round to oval, finely vesicular nuclei. Immunohistochemical findings confirmed the diagnosis of intraspinal peripheral primitive neuroectodermal tumor. Conclusion After this illustrative case, we review the literature on clinicopathological and therapeutic aspects. In practice, it is important to consider the diagnosis of peripheral primitive neuroectodermal tumor in children and adolescents with an apparent soft-tissue mass located in the spine.
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Affiliation(s)
- Mouna Khmou
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco. .,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco.
| | - Abderrahmane Malihy
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
| | - Najat Lamalmi
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
| | - Lamia Rouas
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
| | - Zaitouna Alhamany
- Department of Pathology, Children's Hospital, Ibn Sina University Hospital, Ibn Sina bd Ibn Rochd, Souissi, 10100, Rabat, Morocco.,Faculty of Medicine and Pharmacy Rabat, University Mohammed V, Rabat, Morocco
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Adult Primary Spinal Epidural Extraosseous Ewing's Sarcoma: A Case Report and Review of the Literature. Case Rep Neurol Med 2016; 2016:1217428. [PMID: 27610254 PMCID: PMC5005550 DOI: 10.1155/2016/1217428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/17/2016] [Indexed: 01/09/2023] Open
Abstract
Background. Extraosseous Ewing's sarcoma in the spinal epidural space is a rare malignancy, especially in adults. Case Presentation. A 40-year-old male presented with back pain and urinary hesitancy. MRI revealed a thoracic extradural mass with no osseous involvement. He underwent surgery for gross total resection of the mass, which was diagnosed as Ewing's sarcoma. He was subsequently treated with chemoradiotherapy. He remains disease-free 1 year after surgery. Review of the literature indicated only 45 previously reported cases of spinal epidural extraosseous Ewing's sarcoma in adults. Conclusions. Extraosseous Ewing's sarcoma in the spinal epidural space is a rare clinical entity that should be included in the differential for spinal epidural masses. Its treatment is multidisciplinary but frequently requires surgical intervention due to compressive neurologic symptoms. Gross total resection appears to correlate with improved outcomes.
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Qi W, Deng X, Liu T, Hou Y, Yang C, Wu L, Fang J, Tong X, Yang J, Xu Y. Comparison of Primary Spinal Central and Peripheral Primitive Neuroectodermal Tumors in Clinical and Imaging Characteristics and Long-Term Outcome. World Neurosurg 2015; 88:359-369. [PMID: 26748171 DOI: 10.1016/j.wneu.2015.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Primary spinal primitive neuroectodermal tumors are extremely rare entities. The purpose of this study was to analyze the differences in clinical and imaging characteristics and outcomes between primary spinal central PNETs (cPNETs) and peripheral PNETs (pPNETs). METHODS There were 25 consecutive patients with primary spinal primitive neuroectodermal tumors enrolled. The diagnosis was cPNET in 6 patients with negative CD99 expression and pPNET in 19 patients with positive CD99 expression. Gross total resection (GTR) was achieved in 12 patients, subtotal resection was performed in 9 patients, and partial resection was performed in 4 patients. Postoperative chemotherapy was given to 14 patients, and radiotherapy was given to 16 patients. RESULTS The age at diagnosis was significantly younger in the cPNET group (mean 12.8 years) compared with the pPNET group (mean 22.5 years) (P = 0.040); the 2 pathologies did not show a significant difference in prognosis. GTR (P = 0.041), radiotherapy (P = 0.008), and GTR with radiotherapy (P = 0.009) were significant factors leading to a higher 2-year survival rate. Kaplan-Meier analysis showed that radiotherapy (P < 0.001) and GTR with radiotherapy (P = 0.040) resulted in a longer median survival time. Patients who underwent GTR, chemotherapy, and radiotherapy all together had the highest 1-year (100.0%) and 2-year (71.4%) survival rates and the longest median survival time (32 months). CONCLUSIONS Patients with spinal cPNETs were younger compared with patients with pPNETs. The prognosis of spinal cPNETs and pPNETs was poor with no significant difference between the entities. The most beneficial treatment modality is GTR combined with adjuvant radiotherapy and chemotherapy.
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Affiliation(s)
- Wei Qi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tie Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingzhi Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chenlong Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyi Fang
- Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xianzeng Tong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yulun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Clinical presentation and long-term outcome of primary spinal peripheral primitive neuroectodermal tumors. J Neurooncol 2015; 124:455-63. [PMID: 26186903 DOI: 10.1007/s11060-015-1859-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/12/2015] [Indexed: 12/25/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare entities that predominantly occur in children and young adults. Few studies have reported more than three cases. There are no current optimum treatment strategies due to the paucity of data. Here, we present 13 patients (nine females and four males) with primary intraspinal pPNETs who were surgically treated from April 2008 to February 2014. Histopathologic findings revealed the expression of CD99 in all cases. Limb weakness was the most common initial symptom (11/13, 85 %). The tumors were located mainly at the cervical level (6/13, 46 %) and in the epidural space (10/13, 77 %). The radiological diagnosis was neurinoma or meningioma in most cases (10/13, 77 %). Gross total resection was achieved in 77 % (10/13) of patients. During a mean follow-up of 25.5 months, local relapse occurred in 8 (61.5 %) patients and distant metastases occurred in 8 (61.5 %) patients. The overall 1-year survival rate was 77 % (10/13), and the overall 2-year survival rate was 54 % (7/13). The 2-year survival rate was 57.1 % in patients with adjuvant chemotherapy and 50 % in those without chemotherapy. Gross total resection and adjuvant radiotherapy with or without chemotherapy demonstrated a longer survival period (1-year survival rate: 100 %; 2-year survival rate: 86 %). Our data showed that primary spinal pPNETs are extremely rare and aggressive tumors with a poor prognosis. Radical resection is advocated. Gross total resection combined with adjuvant radiation may help to significantly improve patient survival period. Chemotherapy may also help to slightly prolong patient life.
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Mirzaei L, Kaal SE, Schreuder HW, Bartels RH. The Neurological Compromised Spine Due to Ewing Sarcoma. What First. Neurosurgery 2015; 77:718-24; discussion 724-5. [DOI: 10.1227/neu.0000000000000903] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The vertebral column is an infrequent site of primary involvement in Ewing sarcoma. Yet when Ewing sarcoma is found in the spine, the urge for decompression is high because of the often symptomatic compression of neural structures. It is unclear in alleviating a neurological deficit whether chemotherapy is preferred over decompressive laminectomy.
OBJECTIVE:
To underline, in this case series, the efficiency of initial chemotherapy before upfront surgery in the setting of high-grade spinal cord or cauda equina compression of primary Ewing sarcoma.
METHODS:
Fifteen patients with Ewing sarcoma primarily located in the spine were treated at our institution between 1983 and 2015. Localization, neurological deficit expressed as Frankel grade, and outcome expressed as Rankin scale before and after initial chemotherapy, the recurrence rate, and overall survival were evaluated. The multidisciplinary approach of 1 case will be discussed in detail.
RESULTS:
Nine patients (60%) were female. The age at presentation was 15.0 ± 5.5 years (range: 0.9–22.8 years). Ten patients (67%) were initially treated with chemotherapy, and 1 patient (7%) was treated primarily with radiotherapy followed by chemotherapy. The remaining 4 patients (27%) were initially treated with decompressive surgery. All patients treated primarily nonsurgically improved neurologically at follow-up, showing the importance of chemotherapy as an effective initial treatment option.
CONCLUSION:
Adequate and quick decompression of neural structures with similar results can be achieved by chemotherapy and radiotherapy, avoiding the local spill of malignant cells.
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Affiliation(s)
- Lida Mirzaei
- Radboud University Nijmegen, Medical Faculty, Nijmegen, The Netherlands
| | - Suzanne E.J. Kaal
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | | | - Ronald H.M.A. Bartels
- Radboud University Medical Center, Department of Neurosurgery, Nijmegen, The Netherlands
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Wang J, Wang W, Li Y, Jin B, Yu M, Liu W, Yao S, Liao Y, Ouyang C. A Primary Primitive Neuroectodermal Tumor Arising from Left Subclavian Vein and Extending along Left Brachiocephalic Vein and Superior Vena Cava into Right Atrium. Ann Vasc Surg 2015; 29:839.e13-20. [PMID: 25725277 DOI: 10.1016/j.avsg.2014.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 11/14/2014] [Accepted: 12/14/2014] [Indexed: 11/15/2022]
Abstract
Primitive neuroectodermal tumor (PNET) is an extremely rare malignancy thought to be derived from fetal neuroectodermal precursor cells. It usually occurs in central and peripheral nervous system or soft tissue and bone, while intravenous or intracavitary PNET is considered as an extremely rare tumor. We reported a case of a 44-year-old woman who presented with the left unilateral facial and neck swelling. Magnetic resonance imaging revealed a tape-shaped solid mass within left subclavian vein, left brachiocephalic vein, superior vena cava, and right atrium; the proximal end proportion occupied almost the entire right atrium with a pedicle flip protruded into the right ventricle. Ultrasonography revealed an irregular hypoechnoic mass arising from the left subclavian vein, which extended along the left brachiocephalic vein and superior vena cava into the right atrium and up to the right ventricle. Positron emission tomography-computed tomography revealed several hypermetabolic thyroid nodules with no evidence of intravenous hyperactive lesion. The patient underwent tumor resection under cardiopulmonary bypass. At 15 days postoperatively, total thyroidectomy and resection of the left subclavian vein were simultaneously performed. The patient received chemotherapy and radiotherapy later. Histologically, the neoplasm displayed small, round, blue cells with hyperchromatic nuclei and scant cytoplasm. The neoplastic cells showed a strong immunopositivity for CD99, synaptophysin, CD56, CD57, and friend leukemia integration 1, thus confirming a diagnosis of the PNET. Histopathological examination of the thyroid showed papillary carcinoma. Thus, this PNET had no definitive organ or tissue of origin, which primarily originated from the left subclavian vein with tumor extension along the superior vena cava to the right ventricle.
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Affiliation(s)
- Jian Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weici Wang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiqing Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi Jin
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Miao Yu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenqi Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaohua Yao
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yonggui Liao
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenxi Ouyang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Khan I, Bangash M, Baeesa S, Jamal A, Carracedo A, Alghamdi F, Qashqari H, Abuzenadah A, AlQahtani M, Damanhouri G, Chaudhary A, Hussein D. Epidemiological trends of histopathologically WHO classified CNS tumors in developing countries: systematic review. Asian Pac J Cancer Prev 2015; 16:205-16. [PMID: 25640353 DOI: 10.7314/apjcp.2015.16.1.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many developing countries are lagging behind in reporting epidemiological data for individual central nervous system (CNS) tumors. This paper aimed to elicit patterns for the epidemiology of individual World Health Organization (WHO) classified CNS tumors in countries registered by WHO as "developing". MATERIALS AND METHODS Cyber search was carried out through 66 cancer networks/registries and 181 PubMed published papers that reported counts of CNS tumors for the period of 2009-2012. The relationship between the natural log of incidence Age Standardized Rate (ASR) reported by Globocan and Latitude/ Longitude was investigated. RESULTS Registries for 21 countries displayed information related to CNS tumors. In contrast tends for classified CNS tumor cases were identified for 38 countries via 181 PubMed publications. Extracted data showed a majority of unclassified reported cases [PubMed (38 countries, 45.7%), registries (21 countries, 96.1%)]. For classified tumors, astrocytic tumors were the most frequently reported type [PubMed (38 countries, 1,245 cases, 15.7%), registries (21 countries, 627 cases, 1.99%]. A significant linear regression relationship emerged between latitudes and reported cases of CNS tumors. CONCLUSIONS Previously unreported trends of frequencies for individually classified CNS tumors were elucidated and a possible link of CNS tumors occurrence with geographical location emerged.
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Affiliation(s)
- Ishaq Khan
- Center of Excellence in Genomic Medicine, King Abdulaziz University, Jeddah, Saudi Arabia E-mail :
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Cole M, Parajuli S, Laske D, Goldstein L, Morrison T, Mukherjee A, Tumelty K, Tetzlaff E, von Mehren M, Inniss S. Peripheral primitive neuroectodermal tumor of the dura in a 51-year-old woman following intensive treatment for breast cancer. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:294-9. [PMID: 25045413 PMCID: PMC4102603 DOI: 10.12659/ajcr.890656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
PATIENT Female, 51. FINAL DIAGNOSIS Ewing sarcoma. SYMPTOMS Visual disturbances. MEDICATION -. CLINICAL PROCEDURE -. SPECIALTY Oncology. OBJECTIVE Rare disease. BACKGROUND Primitive neuroectodermal tumor/Ewing sarcoma (PNET/EWS) is a round blue cell sarcoma that shows varying degrees of neuroectodermal differentiation. PNET/EWS as a primary intracranial tumor is extremely uncommon. CASE REPORT We report a unique case of peripheral PNET presenting as an intracranial mass in an adult following chemotherapy and radiotherapy for a solid tumor. A 51-year-old woman with previously treated left breast cancer was evaluated for a newly developed brain mass. She underwent craniotomy with resection. Surgical pathology was consistent with a peripheral PNET/EWS with Ewing sarcoma gene translocation. She was treated appropriately with vincristine, cyclophosphamide, and doxorubicin (later dactinomycin) alternating with ifosfamide and etoposide. CONCLUSIONS Although development of PNET/EWS presenting along the CNS is exceedingly rare in adults, establishing the proper diagnosis of this "small blue cell tumor" is critical. The further distinction between central PNET and peripheral PNET can greatly impact both prognosis and treatment. Our case also highlights the importance of considering the impact of prior intensive therapies, including radiation and chemotherapy, on predisposing to future PNET/EWS.
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Affiliation(s)
- Marion Cole
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Shobha Parajuli
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, U.S.A
| | - Douglas Laske
- Department of Neurosurgery, Temple University School of Medicine, Philadelphia, PA, U.S.A
| | - Lori Goldstein
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Tara Morrison
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Abir Mukherjee
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, U.S.A
| | - Kathryn Tumelty
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Eric Tetzlaff
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A
| | - Susan Inniss
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, U.S.A
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Magnetic resonance imaging appearance of primary spinal extradural Ewing's sarcoma: case report and literature review. Clin Neuroradiol 2013; 23:81-5. [PMID: 23657430 DOI: 10.1007/s00062-013-0222-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Primary spinal extradural Ewing's sarcoma (PSEES) or primitive neuroectodermal tumor (PNET) is uncommon. The present study summarizes the magnetic resonance (MR) imaging appearance of PSEES. METHODS Literature search from 1994 to 2012 with our representative case presentation. RESULTS Twenty-one patients, 12 males and 9 females, aged 3 weeks to 44 years, were identified. The thoracic spine was most frequently affected, followed by the cervical, cervicothoracic, and thoracolumbar spine. Superior-inferior extension of lesions was three vertebral levels in 7, two in 7, five in 4, four in 1, one in 1 and unknown in 1. PSEESs appeared isointense in 9 cases, hypointense in 2, hyperintense in 1, and no description in 9 on T1-weighted imaging, while hyperintense in 6, hypointense in 3, heterogeneous in 1, and no description in 11 on T2-weighted imaging. Varying enhancement was noted in 13 cases (62 %), with no description of contrast study in the other 8 cases. Dumbbell-shaped configuration of PSEES was found in 5 cases, foraminal widening in 4, and erosions or scalloping of the adjacent vertebral bodies in 4. CONCLUSION The MR imaging appearance of PSEESs is indistinguishable from other tumors. PSEES should be assumed as the differential diagnosis of spinal extradural tumors in pediatric, adolescent, and young adult patients, and prompt surgical exploration should be performed.
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