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Mata Fernández C, Sebio A, Orcajo Rincón J, Martín Broto J, Martín Benlloch A, Marcilla Plaza D, López Pousa A, Gracia Alegría I, Giuppi M, Collado Ballesteros E, Bernabeu D, de Alava E, Valverde Morales C. Clinical practice guidelines for the treatment of Ewing sarcoma (Spanish Sarcoma Research Group-GEIS). Clin Transl Oncol 2024:10.1007/s12094-024-03602-5. [PMID: 39158802 DOI: 10.1007/s12094-024-03602-5] [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: 03/26/2024] [Accepted: 07/03/2024] [Indexed: 08/20/2024]
Abstract
Ewing sarcoma is a small round-cell sarcoma characterized by gene fusion involving EWSR1 (or another TET family protein like FUS) and an ETS family transcription factor. The estimated incidence of this rare bone tumor, which occurs most frequently in adolescents and young adults, is 0.3 per 100,000/year. Although only 25% of patients with Ewing sarcoma are diagnosed with metastatic disease, historical series show that this is a systemic disease. Patient management requires multimodal therapies-including intensive chemotherapy-in addition to local treatments (surgery and/or radiotherapy). In the recurrent/refractory disease setting, different approaches involving systemic treatments and local therapies are also recommended as well as patient inclusion in clinical trials whenever possible. Because of the complexity of Ewing sarcoma diagnosis and treatment, it should be carried out in specialized centers and treatment plans should be designed upfront by a multidisciplinary tumor board. These guidelines provide recommendations for diagnosis, staging, and multimodal treatment of Ewing sarcoma.
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Affiliation(s)
- Cristina Mata Fernández
- Pediatric and Adolescent Oncohaematology Unit, Hospital Materno-Infantil Gregorio, Marañón, Madrid, Spain.
| | - Ana Sebio
- Medical Oncology Department, Hospital Sant Pau, Barcelona, Spain
| | - Javier Orcajo Rincón
- Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Martín Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, University Hospital General de Villalba, and Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - Antonio Martín Benlloch
- Section Spine Unit. Orthopaedic and Traumatology Department, Dr. Peset University Hospital, Valencia, Spain
| | - David Marcilla Plaza
- Department of Pathology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Isidro Gracia Alegría
- Orthopaedic Oncology Unit, Orthoapedic and Traumatology Department, Hospital Sant Pau, Barcelona, Spain
| | | | | | - Daniel Bernabeu
- Chief of Musculo-skeletal Radiology Section, Radiodiagnosis Service Hospital General Universitario La Paz, Madrid, Spain
| | - Enrique de Alava
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Institute of Biomedicine of Sevilla, IBiS/Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Seville, Spain
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2
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Lenga P, Dao Trong P, Kleineidam H, Unterberg AW, Krieg SM, Ishak B. Advances in the multidisciplinary surgical approach to primary spinal sarcomas: insights from a retrospective case series on outcomes and survival. Acta Neurochir (Wien) 2024; 166:326. [PMID: 39105874 PMCID: PMC11303475 DOI: 10.1007/s00701-024-06199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION The management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices. METHODS We conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery. RESULTS The study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery. CONCLUSIONS Our 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Medical Faculty of Heidelberg University, Heidelberg, Germany.
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Helena Kleineidam
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
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3
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Lyvannak S, Sereyleak B, Kakazu M, Bisiphan H, Jarzembowski J, Camitta B. Pyrites: A Rectal Mass. J Pediatr Hematol Oncol 2024:00043426-990000000-00467. [PMID: 39028189 DOI: 10.1097/mph.0000000000002900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 07/20/2024]
Affiliation(s)
| | | | - Mariko Kakazu
- Japan Heart Children's Medical Center, Kandal, Cambodia
| | - Hor Bisiphan
- Japan Heart Children's Medical Center, Kandal, Cambodia
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Das J, Nath J, R C, Rahaman M, Ahmed S. Ewing's Sarcoma of the Orbit: A Case Report and Literature Review. Cureus 2023; 15:e48592. [PMID: 37954624 PMCID: PMC10640384 DOI: 10.7759/cureus.48592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
Ewing's sarcoma (ES) is a malignant small round cell neuroectodermal tumour primarily affecting children in the first and second decade of life. Since ES is difficult to control, early diagnosis is crucial, and the treatment requires a multimodality approach constituting chemotherapy, surgery and radiotherapy. Here, we present a case of ES of orbit in a 17-year-old female diagnosed in 2021. This case report focuses on the clinicopathological presentation and management principles of this rare manifestation of the disease that unilaterally infiltrated into the extraconal space of the orbit as well as the I/L frontal sinus. The patient underwent chemotherapy and radiation, and she is on follow-up.
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Affiliation(s)
- Jahnabi Das
- Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Chandramouli R
- Department of Radiation Oncology, Krishna Cancer Institute, Cuddalore, IND
| | - Mostafijur Rahaman
- Department of Radiation Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
| | - Shiraj Ahmed
- Department of Pathology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, IND
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5
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Klingberg D, Bae S, Zhou DDX, Sim HW, Cai R, Anazodo A, Grimison P, Lewis C, Lee YC. Association of chemotherapy dose intensity and age with outcomes in patients with Ewing's family sarcoma. Asia Pac J Clin Oncol 2023. [PMID: 37566390 DOI: 10.1111/ajco.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/08/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Ewing's family sarcoma (EFS) is an aggressive malignancy with a peak incidence in adolescents. Multimodal treatment involves surgery and/or radiotherapy, and chemotherapy typically with VDC/IE (vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide). There is a paucity of data for the treatment of adults, with protocols extrapolated from the pediatric setting. This study aimed to assess patterns of care, chemotherapy tolerability across age groups, and outcomes from four Australian sarcoma centers. METHODS ANZSA ACCORD sarcoma database and medical records were used to identify and collect data of patients aged ≥ 10 years with EFS who received VDC/IE between 2010 and 2020. Survival outcomes were analyzed based on chemotherapy received dose intensity (RDI). Clinical predictors of RDI were explored using logistic regression. RESULTS Of 146 patients with EFS, 76 received VDC/IE. The majority had localized disease (65%). Seventy-one percent completed scheduled chemotherapy, with some requiring dose reduction (29%), delay > 7 days (65%), or cycle omission (4%). Hematological toxicity was the main reason for dose reduction/delay. Fifty-seven percent patients achieved an acceptable RDI ≥85%. Compared to those aged 10-19, the odds ratio for acceptable RDI aged 40-59 was 0.20 (95% CI 0.04-0.86, p = 0.04). RDI was an independent prognostic factor for overall survival, after accounting for age, gender, Ewing's type, primary site, and stage (adjusted HR 0.25 [95% CI 0.10-0.63], p = 0.004). CONCLUSION Survival outcomes in EFS were associated with chemotherapy RDI. Older adults more commonly required dose reduction or early cessation of treatment due to toxicity. VDC/IE chemotherapy should be carefully tailored in adults > 40 years.
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Affiliation(s)
- Danielle Klingberg
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Susie Bae
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Di-Xin Zhou
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Hao-Wen Sim
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruilin Cai
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Antoinette Anazodo
- Department of Medical Oncology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Craig Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yeh Chen Lee
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Ioannidou M, Tsotridou E, Samoladas E, Tragiannidis A, Kouskouras K, Sfougaris D, Spyridakis I, Foroulis C, Galli-Tsinopoulou A, Hatzipantelis E. Unusual Manifestation of Extraosseous Ewing Sarcoma: Report of 3 Cases. Balkan J Med Genet 2023; 25:77-81. [PMID: 37265973 PMCID: PMC10230840 DOI: 10.2478/bjmg-2022-0022] [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: 06/03/2023] Open
Abstract
Ewing sarcoma (ES), described as a diffuse endothelioma of the bone, is divided into two categories: osseous and extraosseous, which mainly affects adolescents. Extraosseous Ewing Sarcomas (EES) are rare tumors originating from soft tissues. Their clinical presentation depends mainly on the primary location of the tumor and are highly chemosensitive and radiosensitive. The purpose of this study was to describe the clinical characteristics and outcomes of 3 children with EES and uncommon presentation treated in our Unit. The diagnosis of EES was confirmed by biopsy and cytogenetic analysis with fluorescence in situ hybridization (FISH). Surgical excision was planned as primary treatment, followed by adjuvant chemotherapy according to EURO-E.W.I.N.G protocol. To date, all patients are alive, 1, 3 and 4 years after completion of treatment, with no signs of recurrence or metastasis.
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Affiliation(s)
- M. Ioannidou
- Children’s and Adolescent’s Hematology-Oncology Unit of 2 Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - E. Tsotridou
- Children’s and Adolescent’s Hematology-Oncology Unit of 2 Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - E. Samoladas
- 2 Department of Orthopedic Surgery, Aristotle University of Thessaloniki, “Gennimatas” General Hospital, Thessaloniki, Greece
| | - A. Tragiannidis
- Children’s and Adolescent’s Hematology-Oncology Unit of 2 Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - K. Kouskouras
- Department of Radiology, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - D. Sfougaris
- 1 Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Gennimatas” General Hospital, Thessaloniki, Greece
| | - I. Spyridakis
- 2 Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece
| | - C. Foroulis
- Department of Cardiothoracic Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - A. Galli-Tsinopoulou
- Children’s and Adolescent’s Hematology-Oncology Unit of 2 Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - E. Hatzipantelis
- Children’s and Adolescent’s Hematology-Oncology Unit of 2 Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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Mathew J, Arjunan R, Dasappa A, Namachivayam A. Prognostic Factors and Clinical Outcomes in Extraskeletal Ewing Sarcoma: A Cohort Study. Ann Surg Oncol 2022; 30:3084-3094. [PMID: 36564656 DOI: 10.1245/s10434-022-12992-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Extraskeletal Ewing sarcoma (ESE) is a lesser-known, rarer counterpart of Ewing sarcoma of bone. This single-center study sought to evaluate the prognosticators and outcomes following multimodality therapy in patients with ESE. METHODS Forty-seven patients with ESE, treated between 2013 and 2018 with a standardized protocol and multimodality therapy using established doxorubicin-based regimens, were followed-up to assess outcomes. RESULTS Median age at diagnosis was 20 (range 7-56) years, and 57.4% were male. Median tumor size was 7 (range 2-21) cm. The symptom-duration ranged from 1 to 8 (median 4) months. Tumor-site was trunkal in 61.7%, extremity in 23.4%, and head and neck 14.9%. Of the 35 patients with nonmetastatic disease at presentation, 13 underwent upfront surgery. The rest received chemotherapy followed by local treatment, which was surgical in 15 and radiotherapy in 5. At median follow-up of 24 (range 5-98) months, 55.3% patients had experienced events, and 29.8% had died of progressive disease. Three-year event-free survival was 41.1%, and overall survival was 53%. On univariate analysis, trunkal location, upfront surgery, and positive surgical margins were associated with inferior EFS. Trunkal tumors and upfront surgery were also associated with poorer OS. On multivariate analysis, trunkal location and margin-positive resections retained statistical significance for adverse EFS. CONCLUSIONS Unless clearly resectable upfront, ESE should be downstaged with chemotherapy before local treatment. A margin-negative resection should be the objective when performing surgery. Definitive radiotherapy is an alternative in tumors not amenable for complete excision or when anticipated postoperative morbidity precludes radical surgery.
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Affiliation(s)
- Joseph Mathew
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Ashwathappa Dasappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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8
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Al-Marshad AY, AlMazrua IS, AlMulla F, Alaboud M, Alrifaie O, Shaheen M, Rajeev P. Unusual presentation of Ewing sarcoma; a case report and literature review. Int J Surg Case Rep 2022; 99:107479. [PMID: 36152369 PMCID: PMC9568706 DOI: 10.1016/j.ijscr.2022.107479] [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: 06/05/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Ewing's sarcoma is an aggressive malignancy primarily affecting skeletal system in children and young adults. Case presentation We report an unusual case of Ewing sarcoma in a 14-year-old boy with clinical and radiological features of rapid onset metachronous skeletal metastasis (within 4 weeks of diagnosis). Clinical discussion Although the deterioration of symptoms was very rapid, it is unusual to note that in the presence of such widespread metastatic disease the lungs per se remained uninvolved. Conclusion We describe a unique case of metastatic Ewing's sarcoma who showed rapid systemic disease progression with widespread skeletal metastases (and CNS involvement) but without any evidence of pulmonary involvement. Ewing sarcoma is considered aggressive malignancy primarily affecting skeletal system. It is usually very slowly progressive in nature (years). This case presentation showed aggressiveness behavior with very unpredictable outcomes short period from diagnosis to metastasis. Up to our knowledge, this atypical and rapid disease progression (within a month of diagnosis) was not previously reported in literature.
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9
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Violon F, Burns R, Mihoubi F, Audard V, Biau D, Feydy A, Larousserie F. Intramedullary, periosteal, and extraskeletal Ewing sarcomas: retrospective study of a series of 126 cases in a reference center. Skeletal Radiol 2022; 51:1659-1670. [PMID: 35179621 DOI: 10.1007/s00256-021-03983-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the proportion of extraskeletal, periosteal, and intramedullary Ewing sarcomas among musculoskeletal Ewing sarcomas. MATERIAL AND METHOD Our single-center retrospective study included patients with musculoskeletal Ewing sarcoma diagnosed between 2005 and 2019 in our pathology center (cases from our adult bone tumor referral center and adult and pediatric cases referred for review). Recurrences, metastases, and visceral Ewing sarcomas were excluded. Intramedullary Ewing sarcomas were defined by involvement of the medullary cavity. Periosteal cases were defined by involvement of the subperiosteal area without extension to the medullary cavity. Extraskeletal cases were defined by the absence of involvement of the bone tissue and the subperiosteal area. RESULTS Our series included 126 patients with musculoskeletal Ewing sarcoma, including 118 skeletal Ewing sarcomas (93.7%) and 8 extraskeletal Ewing sarcomas (6.3%). Of the 118 skeletal Ewing sarcomas 112 were intramedullary (88.9%) and 6 were periosteal (4.8%). Extraskeletal Ewing sarcomas were more common in women and in patients older than 40 (p < 0.05). DISCUSSION The 6.3% proportion of extraskeletal Ewing sarcoma is lower than the median of 30% estimated from the literature. This difference could be explained by an overestimation of extraskeletal Ewing sarcomas of the chest wall (Askin tumors), an underestimation of periosteal cases confused with extraskeletal cases, and the presence of "Ewing-like" soft tissue sarcomas in previous series. Because of its prognostic and therapeutic impact, the distinction of morphologic subtypes requires the cooperation of experienced radiologists and pathologists.
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Affiliation(s)
- F Violon
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France.,Faculté de Médecine de Nancy, Université de Lorraine, Nancy, France
| | - R Burns
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - F Mihoubi
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France
| | - V Audard
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France
| | - D Biau
- Université de Paris, Paris, France.,Service de Chirurgie Orthopédique, Hôpital Cochin, AP-HP, Paris, France
| | - A Feydy
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - F Larousserie
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France. .,Université de Paris, Paris, France.
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Wei CH, Thompson LDR, Lee K, Chow W, Liang Y. Outcome for Neoadjuvant Treatment of Parotid Gland Adamantinoma-Like Ewing Sarcoma: Case Report and Review of Literatures. Int J Surg Pathol 2022; 30:776-783. [PMID: 35467446 DOI: 10.1177/10668969221081029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Adamantinoma-like Ewing sarcoma typically shows t(11;22) EWSR1::FLI1 translocation and complex epithelial differentiation. It poses a diagnostic challenge, especially in the head and neck region, due to its under-recognition and significant histologic overlap with other malignancies. Neoadjuvant and adjuvant treatment information on head and neck Adamantinoma-like Ewing sarcoma is limited. Case Presentation. Herein, we report a case of a 78-year-old female with Adamantinoma-like Ewing sarcoma of the parotid gland, including the imaging findings and clinical response to neoadjuvant therapy followed by surgery. The efficacy of neoadjuvant therapy in the treatment of Adamantinoma-like Ewing sarcoma is discussed in the context of a review of pertinent literature. Conclusion. Adamantinoma-like Ewing sarcoma in the head and neck is frequently misdiagnosed as poorly differentiated squamous cell carcinoma or a basaloid salivary gland carcinoma. Adamantinoma-like Ewing sarcoma is a EWS1::FLI1 translocation driven tumor; frequently misdiagnosed on head and neck biopsies as poorly differentiated carcinoma, or squamous cell carcinoma. Ewing sarcoma-specific chemoregimen appears effective for this entity. If diagnosed early, patient may be amenable to neoadjuvant therapy, which may improve surgical and cosmetic outcomes. This is especially important in head and neck regions.
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Affiliation(s)
- Christina H Wei
- Department of Pathology, 378541City of Hope National Medical Center, Duarte, CA, USA
| | - Lester D R Thompson
- 158530Southern California Permanente Medical Group, Department of Pathology, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Kyle Lee
- Department of Pathology, 378541City of Hope National Medical Center, Duarte, CA, USA
| | - Warren Chow
- Department of Medical Oncology and Therapeutics Research, City of Hope Medical Center, Duarte, CA, USA
| | - Yu Liang
- Department of Pathology, 378541City of Hope National Medical Center, Duarte, CA, USA
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11
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Panda G, Chandrasekharan A, Das S, Bhargava P, Srinivas S, Laskar S, Mokal S, Rekhi B, Khanna N, Menon N, Patil V, Noronha V, Joshi A, Prabhash K, Banavali SD, Gupta S, Bajpai J. Outcomes of Ewing sarcoma in adults over 40 years of age from a low-middle income country. Ecancermedicalscience 2022; 16:1361. [PMID: 35685954 PMCID: PMC9085161 DOI: 10.3332/ecancer.2022.1361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction The data on outcomes and toxicity in adult Ewing sarcoma (ES) patients, particularly those aged ≥40 years, is exceedingly scarce around the world, particularly in low- and middle-income countries (LMICs) and mandates research. Methods The study involved histologically ascertained ES patients aged ≥40 years who registered at our institute from 2013 to 2018. Prospectively collected data were analysed for overall survival (OS), event-free survival (EFS) and chemotherapy-related toxicities. Results There were 66 patients, of which 34 were non-metastatic, and 32 were denovo metastatic, recurrent or had doubtful metastasis. At presentation, median age was 46 years, and 42 (63.6%) had extra-skeletal primary and 24 (36.3%) had extremity tumours. Curative treatment was offered to 40 (60.6%) patients. Significant grade 3/4 toxicities in non-metastatic and metastatic cohort, respectively, were febrile neutropenia (61.3%, 37.5%), anaemia (58.1%, 37.5%), thrombocytopenia (45.2%, 25.0%), peripheral neuropathy (25.8%, 12.5%) and dyselectrolytemia (25.8%, 6.25%). Chemotherapy-related toxicity led to death in three patients in the metastatic cohort, versus none in the non-metastatic patients. The 5 year EFS and OS for non-metastatic cohort were 53.8% and 67.8%, while the same for metastatic cohort were 20.7% and 27.5%, respectively. On multivariate analysis, Eastern Cooperative Oncology Group-performance status >2 and metastasis at presentation predicted poorer EFS and OS. Additionally, raised lactate dehydrogenase, larger tumours (>8 cm) and palliative intent treatment predicted worse EFS, while extra-skeletal primary and female gender were indicators of worse OS. Conclusions Older adult ES patients benefit from aggressive multimodality treatment even in LMIC infrastructure. However, careful patient selection, close monitoring and pertinent dose modifications is imperative due to higher propensity for potential toxicities.
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Affiliation(s)
- Goutam Panda
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Shasanka Das
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Smruti Mokal
- Department of Biostatistics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, India
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12
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Shadhu K, Ramlagun-Mungur D, Ping XC. Ewing sarcoma of the jejunum: A case report and literature review. World J Gastrointest Surg 2021; 13:507-515. [PMID: 34122739 PMCID: PMC8167841 DOI: 10.4240/wjgs.v13.i5.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ewing sarcomas (ESs) are highly aggressive malignancy and are predominant in the long bones of extremities of children and young adults with a slight male predilection and rarely presents at extra skeletal locations.
CASE SUMMARY A 55-year-old woman came to our hospital after finding elevated tumor biomarkers during her physical examination. Her enhanced computed tomography scan showed a jejunal mass. The patient underwent laparoscopic enterectomy. The mass was later diagnosed as ES, evidenced by fluorescence in situ hybridization whereby the GLP ES breakpoint region 1 probe was used, showing that more than 10% of the cells showed a red-green-yellow signal proving the breakpoint rearrangement of the ES breakpoint region 1 gene in chromosome 22.
CONCLUSION We describe a case of localized ES at the jejunum in China based on the literature.
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Affiliation(s)
- Kamleshsingh Shadhu
- Department of General Surgery, Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Pre-registration House Officer, Medical Council of Mauritius, Floreal 0000, Plaine Whilhems, Mauritius
| | - Dadhija Ramlagun-Mungur
- Department of General Surgery, Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Pre-registration House Officer, Medical Council of Mauritius, Floreal 0000, Plaine Whilhems, Mauritius
| | - Xiao-Chun Ping
- Department of General Surgery, Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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13
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Abboud A, Masrouha K, Saliba M, Haidar R, Saab R, Khoury N, Tawil A, Saghieh S. Extraskeletal Ewing sarcoma: Diagnosis, management and prognosis. Oncol Lett 2021; 21:354. [PMID: 33747211 DOI: 10.3892/ol.2021.12615] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 02/02/2021] [Indexed: 12/26/2022] Open
Abstract
Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, which accounts for 20-30% of all reported cases of ES. Being uncommon, all members of the ES family tumors are treated following the same general protocol of sarcoma tumors. The present review summarizes the diagnosis, management and prognosis of EES, focusing on the differences between the subtypes of ESS. The clinical features and imaging of EES are also discussed. Magnetic resonance imaging is the modality of choice for diagnostic imaging and local staging, while core-needle biopsy with pathological testing is used to obtain a definitive diagnosis. Although several oncology groups endorse that ES family of tumors should be treated with similar algorithm and protocols, some studies have demonstrated that surgery and radiotherapy may be used as a form of local control. However, further studies are required to conclude the optimum treatment option for EES.
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Affiliation(s)
- Abdallah Abboud
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Karim Masrouha
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, NYU Langone Health, New York, NY 10016, USA
| | - Maelle Saliba
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Rachid Haidar
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Nabil Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Ayman Tawil
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Said Saghieh
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1013, Lebanon
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14
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15
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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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16
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Alvarez-SanNicolas J, Gracia-Alegria I, Trullols-Tarrago L, Peiro-Ibañez A, Lamas-Gomez C. Prognostic factors and survival in Ewing's sarcoma treated by limb salvage surgery. Clin Transl Oncol 2019; 21:1374-1382. [PMID: 30798513 DOI: 10.1007/s12094-019-02067-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/15/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Survival in Ewing's sarcoma (ES) has increased with the use of chemotherapy. Surgical techniques such as limb salvage (LS) have been developed. Survival and adverse events have been widely studied in general series of ES, but there are few specific series of ES cases treated by LS, despite this being the most commonly used (surgical) approach. The aim of this study was to determine survival and prognostic factors in ES patients undergoing LS. PATIENTS AND METHODS We analysed all ES patients treated between January 1984 and May 2008 and selected all those treated by systemic multimodal therapy and LS. We assessed the influence of patient characteristics, tumour parameters and therapeutic results in event-free survival (EFS). RESULTS Ninety patients were included. Fifty of them were treated by systemic multimodal therapy and locally by LS. ean age was 20 years. Overall survival (OS) was 68.8% and EFS was 60.6% at years. In the univariate analysis, pelvic location, age and response to chemotherapy were associated with poor prognosis. After multivariate analysis, poor response to treatment, pelvis location and age between 12 and 17 years were found to be independent prognostic factors. Dissemination at diagnosis was not a prognostic factor. CONCLUSIONS OS and EFS in ES treated by LS were similar to findings in previous ES studies. factors are no different, except for the presence of metastasis at diagnosis.
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Affiliation(s)
- J Alvarez-SanNicolas
- Department of Orthopaedic Surgery, Hospital Sant Joan Despí Moisès Broggi, C/ Jacint Verdaguer, 08970, Sant Joan Despí, Barcelona, Spain.
| | - I Gracia-Alegria
- Department of Oncological Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Trullols-Tarrago
- Department of Oncological Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Peiro-Ibañez
- Department of Oncological Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Lamas-Gomez
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Rhabdomyosarcoma and Extraosseous Ewing Sarcoma. CHILDREN-BASEL 2018; 5:children5120165. [PMID: 30544742 PMCID: PMC6306718 DOI: 10.3390/children5120165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022]
Abstract
Rhabdomyosarcoma (RMS) is a malignant tumor that represents the most common form of pediatric soft tissue sarcoma. It arises from mesenchymal origin and forms part of the group of small round blue cell tumors of childhood. It has a constant annual incidence of 4.5 cases per 1,000,000 children. The known histological diagnosis of the two major subtypes (embryonal and alveolar) has been recently enhanced by tumor biological markers and molecular differentiation diagnostic tools that have improved not only the updated classification based on risk stratification, but also the treatment approach based on the clinical group. Ewing sarcoma (ES) is a round cell tumor, highly malignant and poorly differentiated that is currently the second most common malignant bone tumor in children. In rare instances, it develops from an extraskeletal origin, classified as extraosseous Ewing sarcoma (EES). We provide an updated, evidence-based and comprehensive review of the molecular diagnosis, clinical and diagnostic approach and a multidisciplinary medical and surgical management according to the latest standard of care for the treatment of pediatric RMS and EES.
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18
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Worch J, Ranft A, DuBois SG, Paulussen M, Juergens H, Dirksen U. Age dependency of primary tumor sites and metastases in patients with Ewing sarcoma. Pediatr Blood Cancer 2018; 65:e27251. [PMID: 29856530 DOI: 10.1002/pbc.27251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/20/2018] [Accepted: 05/02/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The median age of patients with Ewing sarcoma (EwS) at diagnosis is around 14-15 years. Older age is associated with a worse outcome. The correlation of age at diagnosis on sites of disease has not been fully described. OBJECTIVE The goal of this study was to evaluate the differences in sites of primary tumor and metastatic tumor involvement according to age groups. DESIGN/METHOD EwS data from the Gesellschaft für Pädiatrische Onkologie und Hämatology (GPOH) database of the Cooperative Ewing Sarcoma Study (CESS) 81/86 and the European Intergroup Cooperative Ewing's Sarcoma Study EICESS 92 and the EUROpean Ewing tumor Working Initiative of National Groups-99-Protocol (EURO-E.W.I.N.G.-99) study were analyzed. Patient and tumor characteristics were evaluated statistically using chi square tests. RESULTS The study population included 2,635 patients with bone EwS. Sites of primary and metastatic tumors differed according to the age groups of young children (0-9 years), early adolescence (10-14 years), late adolescence (15-19 years), young adults (20-24 years), and adults (more than 24 years). Young children demonstrated the most striking differences in site of disease with a lower proportion of pelvic primary and axial tumors. They presented less often with metastatic disease at diagnosis. CONCLUSIONS Site of primary and metastatic tumor involvement in EwS differs according to patient age. The biological and developmental etiology for these differences requires further investigations.
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Affiliation(s)
- Jennifer Worch
- Department of Pediatric Hematology/Oncology, University Hospital Muenster, Westfalian Wilhelms University Muenster, Münster, Germany
| | - Andreas Ranft
- University Hospital Essen, Pediatrics III, Sarcoma Centre, West German Cancer, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Michael Paulussen
- Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
| | - Heribert Juergens
- Department of Pediatric Hematology/Oncology, University Hospital Muenster, Westfalian Wilhelms University Muenster, Münster, Germany
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, Sarcoma Centre, West German Cancer, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
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19
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Bong C, Thomson I, Lampe G. Case report and literature review of Ewing's sarcoma in the gastrointestinal tract. SURGICAL PRACTICE 2018; 22:84-92. [DOI: 10.1111/1744-1633.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Christopher Bong
- Department of Upper Gastrointestinal Surgery and Soft Tissue; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Iain Thomson
- Department of Upper Gastrointestinal Surgery and Soft Tissue; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Guy Lampe
- Department of Anatomical Pathology; Princess Alexandra Hospital; Woolloongabba Queensland Australia
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20
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Bang JS, Adsul N, Lim JH, Jang IT. Extra-Osseous Ewing Sarcoma of Sciatic Nerve Masquerading as Benign Nerve Sheath Tumor and Presented as Lumbar Radiculopathy: Case Report and Review of Literature. World Neurosurg 2018; 115:89-93. [PMID: 29673820 DOI: 10.1016/j.wneu.2018.04.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Extraosseous Ewing sarcoma (EES) arising from peripheral nerves is extremely rare with only 11 cases mentioned in the literature. It poses a diagnostic challenge to the clinicians due to its nonspecific presentation and rare occurrence. CASE DESCRIPTION A 56-year-old woman came with a history of low back pain and intractable right leg pain. Physical examination revealed the normal motor power of both lower limbs with decreased sensation along the lateral aspect of the foot with decreased ankle reflex. There was no improvement with conservative management. It was a diagnostic challenge due to its presentation like a lumbar radiculopathy, which was further endorsed by magnetic resonance imaging findings of foraminal stenosis. Due to red flags such as unrelenting pain at rest and history of thyroid tumor, we proceeded with magnetic resonance imaging of the hip, which was suggestive of right sciatic nerve sheath tumor. Excisional biopsy was confirmed as EES, and the patient was subsequently started on chemoradiotherapy. CONCLUSION A high index of suspicion is required for early diagnosis of EES. It can present as lumbar radiculopathy and mimic benign nerve sheath tumor on imaging. These sarcomas must be managed with a multidisciplinary approach.
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Affiliation(s)
- Jung Soo Bang
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea.
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
| | - Jae-Hyeon Lim
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
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21
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Bar-Sela G, Peer A, Rothschild S, Haim N. Treatment of Patients Aged over 50 Years with Non-Osseous Ewing's Sarcoma Family Tumors: Five Cases and Review of Literature. TUMORI JOURNAL 2018; 94:809-12. [DOI: 10.1177/030089160809400606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Most clinical trials on Ewing's sarcoma family of tumors include pediatric and adolescent populations, whereas clinical data on older patients are limited. Patients and Methods We report on 5 patients older than 50 years with a tumor of the Ewing's sarcoma family treated recently in our department. Results Myelosuppression and infectious complications were the main toxicity encountered. Major dose reductions and/or treatment delays were required in all 5 patients. One patient died of septic shock. Complete remission was achieved in the remaining 4 patients with the addition of different treatment modalities. One patient had lung metastasis 3 years after starting chemotherapy, and 3 patients have remained without evidence of recurrent disease for 1–6 years from the onset of chemotherapy. Conclusions There is no definite answer as to whether older age is a poor prognostic factor in patients with a tumor of the Ewing's sarcoma family. In our experience, patients over 50 poorly tolerated the standard chemotherapy protocol used in the pediatric population.
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Affiliation(s)
- Gil Bar-Sela
- Division of Oncology, Rambam-Health Care Campus, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | - Avivit Peer
- Division of Oncology, Rambam-Health Care Campus, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | - Shelly Rothschild
- Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Nissim Haim
- Division of Oncology, Rambam-Health Care Campus, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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22
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Rochefort P, Italiano A, Laurence V, Penel N, Lardy-Cleaud A, Mir O, Chevreau C, Bertucci F, Bompas E, Chaigneau L, Levy D, Ryckewaert T, Dumont S, Meeus P, Ranchere D, Blay JY, Cassier PA. A Retrospective Multicentric Study of Ewing Sarcoma Family of Tumors in Patients Older Than 50: Management and Outcome. Sci Rep 2017; 7:17917. [PMID: 29263409 PMCID: PMC5738347 DOI: 10.1038/s41598-017-17733-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022] Open
Abstract
Ewing's sarcoma family of tumors (EFTs) is a group of rare and aggressive tumors. Data on EFTs in patients (pts) ≥ 50 years are limited and these pts are often not eligible for clinical trials. Some, but not all, studies have reported inferior outcome for older pts with EFTs. We conducted an IRB-approved retrospective analysis among centers of the French Sarcoma Group on pts diagnosed with EFTs at age ≥50 between 2000 and 2012. Clinical features, treatment modality and outcomes were analyzed. Seventy-seven pts were identified, including 36 females (46.8%) and the median age at diagnosis was 56 years (range: 50-86). The primary tumor was located in soft tissue in 59 pts (76.6%). Fifty-six pts (72.7%) had localized disease, among them 49 (87.5%) received chemotherapy in addition to local therapy. Their estimated 3-yr OS and event-free survival (EFS) rates were respectively 73.3% and 62.2%. Recurrence occurred in 43 pts. The estimated 3-yr OS rate was 37% in pts with metastatic disease at presentation. EFTs in pts ≥50 years are more likely to originate from soft tissue and their outcomes appear to be worse than that of younger pts treated with modern protocols.
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Affiliation(s)
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Olivier Mir
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, St. Herblain, Saint-Herblain, France
| | - Loic Chaigneau
- Department of Medical Oncology, Hôpital Jean Minjoz, Besançon, France
| | - Dominique Levy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Sarah Dumont
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Pierre Meeus
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
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23
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Bedard J, Burns J, de Comas A. Periosteal Ewing Sarcoma in a 65-Year-Old Man: A Case Report. JBJS Case Connect 2017; 7:e27. [PMID: 29244667 DOI: 10.2106/jbjs.cc.16.00168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Ewing sarcoma is predominantly a pediatric bone malignancy involving the medullary canal. Periosteal Ewing sarcoma, a subtype arising from the periosteum, is exceedingly rare, with approximately 30 reported cases in the literature. We describe a case of periosteal Ewing sarcoma in the tibia of a 65-year-old man. Magnetic resonance imaging revealed a heterogeneous mass in the proximal tibial diaphysis without medullary involvement. The diagnosis was confirmed histologically after biopsy. The patient was treated with neoadjuvant chemotherapy, radical resection, and adjuvant chemotherapy. CONCLUSION To the best of our knowledge, this case report describes the oldest documented patient with periosteal Ewing sarcoma.
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Affiliation(s)
- Julia Bedard
- Department of Orthopaedics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Jessica Burns
- Department of Orthopaedics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Amalia de Comas
- The CORE Institute, Phoenix, Arizona.,The Banner MD Anderson Cancer Center, Gilbert, Arizona
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24
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Pretz JL, Barysauskas CM, George S, Hornick JL, Raut CP, Chen YLE, Marcus KJ, Choy E, Hornicek F, Ready JE, DeLaney TF, Baldini EH. Localized Adult Ewing Sarcoma: Favorable Outcomes with Alternating Vincristine, Doxorubicin, Cyclophosphamide, and Ifosfamide, Etoposide (VDC/IE)-Based Multimodality Therapy. Oncologist 2017; 22:1265-1270. [PMID: 28550026 PMCID: PMC5634761 DOI: 10.1634/theoncologist.2016-0463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/10/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In children with localized Ewing sarcoma (ES), addition of ifosfamide and etoposide to cyclophosphamide, doxorubicin, and vincristine (VDC/IE) improved 5-year overall survival (OS) to 70%-80%. Prior to delivery of VDC/IE in adults, 5-year OS was <50%. We reviewed our institutional outcomes for adults with ES who received VDC/IE-based treatment. MATERIALS AND METHODS Between 1997-2013, 67 adults with localized ES were treated with curative intent. Local recurrence-free survival (LRFS), progression-free survival (PFS), and OS were determined using Kaplan-Meier method; comparisons were assessed with log-rank. Proportional hazard models were used to determine predictive factors. RESULTS All patients received VDC/IE (median 14 cycles.) Local therapy was surgery for 33, radiation therapy for 17, or both for 17. Median follow-up for living patients was 5.2 years. Six patients had disease progression on therapy. Site of first failure was local for three, local and distant for two, and distant for ten. Five-year LRFS was 91%; 5-year LRFS was 96% for nonpelvic disease and 64% for pelvic disease (p = .003). Five-year PFS was 66%, and 5-year OS was 79%. On multivariate analysis, pelvic site had a 3.3 times increased risk of progression (p = .01). CONCLUSION Survival for adults with localized ES treated with VDC/IE-based multimodality therapy appears to be better than historical data and similar to excellent outcomes in children. Pelvic site of disease remains a predictor of worse outcome. Given the paucity of literature for adult ES, these data help validate VDC/IE-based therapy as an appropriate treatment approach for this rare disease in adults. IMPLICATIONS FOR PRACTICE Ewing sarcoma (ES) is rare in adults. Treatment approaches for adults have been extrapolated from the pediatric experience, and there is a sense that adults fare less well than children. We reviewed treatment outcomes in adults with localized ES treated with cyclophosphamide, doxorubicin, and vincristine in alternation with ifosfamide and etoposide (VDC/IE) as part of multimodality therapy. Survival outcomes appear to be better than historical data for adults and similar to the excellent outcomes for children. These data help validate VDC/IE-based therapy as an appropriate treatment approach for this rare disease in adults.
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Affiliation(s)
- Jennifer L Pretz
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Constance M Barysauskas
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Suzanne George
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Jason L Hornick
- Department of Pathology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Chandrajit P Raut
- Department of Surgical Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Yen-Lin E Chen
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Edwin Choy
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francis Hornicek
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John E Ready
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Thomas F DeLaney
- Department of Surgical Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
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25
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Ewing sarcoma in patients over 40 years of age: a prospective analysis of 31 patients treated at a single institution. TUMORI JOURNAL 2016; 102:481-487. [PMID: 27443894 DOI: 10.5301/tj.5000534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Patients with Ewing sarcoma who are 40 years old or older are usually excluded from clinical trials. For this reason, information on this subset of patients is limited. METHODS Clinical characteristics and treatment-related variables of patients aged 40 years or more, with a diagnosis of Ewing sarcoma, treated at the authors' institution had been prospectively collected since 1999. RESULTS Thirty-one patients were identified, with ages ranging from 40 to 70 years (median 45 years). Twenty-six (84%) had localized disease, 4 patients presented with lung metastases, and 1 patient had multiple metastases (bone, lung, abdominal nodes, and bone marrow). The primary tumors were skeletal in 19 (61%) patients, while 12 (39%) had extraskeletal disease. All patients received chemotherapy according to regimens similar to those adopted in younger patients, based on doxorubicin, cyclophosphamide, etoposide, vincristine, dactinomycin, and ifosfamide. All patients experienced grade 4 leukopenia (100%); red blood cells or platelets transfusions were needed in 50% and 16% of patients, respectively. Toxicity-related dose reduction was required in 13 patients (43%). The 5-year overall survival (OS) was 54% for the whole group. In patients with complete remission, 5-year disease-free survival was 57%. Survival was different for patients with skeletal and extraskeletal Ewing sarcoma (5-year OS: 64% vs 40%, p = 0.2). CONCLUSIONS In older patients, the incidence of extraskeletal Ewing sarcoma is high. Intensive chemotherapy treatment can be recommended in this group. The high chemotherapy toxicity can be justified by expected results, similar to those of younger patients.
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Gambarotti M, Benini S, Gamberi G, Cocchi S, Palmerini E, Sbaraglia M, Donati D, Picci P, Vanel D, Ferrari S, Righi A, Dei Tos AP. CIC-DUX4 fusion-positive round-cell sarcomas of soft tissue and bone: a single-institution morphological and molecular analysis of seven cases. Histopathology 2016; 69:624-34. [PMID: 27079694 DOI: 10.1111/his.12985] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/10/2016] [Indexed: 01/17/2023]
Abstract
AIMS Round-cell sarcomas lacking specific translocations represent a diagnostic challenge. The aim of this study was to describe seven cases of CIC-DUX4 fusion-positive sarcomas, including the first reported example arising primarily in bone. METHODS AND RESULTS Patients ranged in age from 15 years to 44 years (median: 33 years). Six cases arose from the soft tissues, and one from the iliac bone. Morphologically, all cases showed an undifferentiated round-cell population with greater atypia and pleomorphism than Ewing sarcoma. Immunohistochemically, all tumours showed focal and weak positivity for CD99, and five of seven showed nuclear and/or cytoplasmic positivity for Wilms tumour 1. Five patients had lung metastases at presentation. All patients received chemotherapy according to Ewing sarcoma protocols. All but one patient (the one with a bone tumour) died of disease after a mean of 14.5 months from the diagnosis (range: 8-20 months). CONCLUSIONS Our series confirms that CIC-DUX4 fusion-positive sarcomas are aggressive tumours with an adverse prognosis, and with clinical, histological and genetic differences from Ewing sarcoma. The best therapeutic approach needs to be investigated.
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Affiliation(s)
| | | | - Gabriella Gamberi
- Department of Pathology, Rizzoli Institute, Bologna, Italy.,Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | | | | | - Marta Sbaraglia
- Department of Pathology, Treviso Regional Hospital, Treviso, Italy
| | - Davide Donati
- Department of Orthopaedic Oncology, Rizzoli Institute, Bologna, Italy
| | - Piero Picci
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - Daniel Vanel
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | | | - Alberto Righi
- Department of Pathology, Rizzoli Institute, Bologna, Italy.
| | - Angelo P Dei Tos
- Department of Pathology, Rizzoli Institute, Bologna, Italy.,Department of Pathology, Treviso Regional Hospital, Treviso, Italy
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Tan QT, Teo JY, Ahmed SS, Chung AYF. A case of small bowel metastasis from spinal Ewing sarcoma causing intussusception in an adult female. World J Surg Oncol 2016; 14:109. [PMID: 27083867 PMCID: PMC4833955 DOI: 10.1186/s12957-016-0850-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/24/2016] [Indexed: 11/16/2022] Open
Abstract
Background Ewing sarcomas are highly aggressive malignant tumours occurring predominantly in the long bones of the extremities in children and young adults. About 20 % of patients will present with metastases at diagnosis with the commonest sites being the lungs, bone and bone marrow. Cases of primary small bowel Ewing sarcomas have been described but are nonetheless exceedingly rare, even more so cases of metastasis to the small bowel. Case Presentation We describe a case of vertebral Ewing sarcoma in a 44 year-old female which metastasized to the jejunum causing intussusception. Conclusions Ewing’s sarcoma is highly aggressive and presence of metastases, overt or subclinical, is thought to be present in almost all patients at diagnosis. As evidenced by our patient, metastatic disease can progress rapidly to cause further complications and confer a poorer survival. The possibility of metastasis, no matter how rare or unlikely the site is, should be considered and actively investigated to expedite treatment of the primary disease.
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Affiliation(s)
- Qing Ting Tan
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Jin Yao Teo
- Department of Hepatopancreaticobiliary Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Syed Salahuddin Ahmed
- Department of Pathology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreaticobiliary Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Mizuguchi K, Minato H, Onishi H, Mitani Y, Kawai J. Cytopathological findings of primary pulmonary Ewing family of tumors with EWSR1 translocation: A case report. Thorac Cancer 2016; 7:602-606. [PMID: 27766786 PMCID: PMC5125323 DOI: 10.1111/1759-7714.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/11/2016] [Indexed: 10/27/2022] Open
Abstract
Primary pulmonary neoplasms of the Ewing family of tumors (EFT) are extremely rare and usually occur in adolescents or young adults. Only about 40 cases of pulmonary EFT have been reported in English literature, and no cytological studies have been documented. In this report, we describe the cytopathological findings of a primary pulmonary EFT in an elderly patient. A 70-year-old man sought care because of a progressing cough and dyspnea. Chest computed tomography revealed a circumscribed mass of 6 cm in the left upper lobe. Fine needle aspiration cytology and core needle biopsy revealed uniform round cell proliferation. The predominant population consisted of cells with thickened nuclear membranes, finely dispersed chromatin, single distinct nucleoli, and indistinct cytoplasm. The other population consisted of smaller cells with darker chromatin. The cytoplasm stained positive for periodic acid-Schiff stain and was digested by diastase. Immunohistochemistry showed positivity for MIC2 (CD99), and focal positivity for neuron specific enolase, synaptophysin, and chromogranin A. Fluorescence in situ hybridization (FISH) revealed EWSR1 translocation. Although rare, pulmonary EFT cannot be disregarded, regardless of age. When two populations of uniform, round cells are observed, immunohistochemistry with MIC2 (CD99) and cytogenetic analysis by reverse transcription polymerase chain reaction or FISH should be considered. Cytological diagnosis may play an important role in the early diagnosis and treatment of pulmonary EFT.
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Affiliation(s)
- Keishi Mizuguchi
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
| | - Hiroshi Minato
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hitomi Onishi
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
| | - Yuki Mitani
- Department of Clinical Laboratory, Japan Community Healthcare Organization Kanazawa Hospital, Ishikawa, Japan
| | - Jun Kawai
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
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Karski EE, Mcilvaine E, Segal MR, Krailo M, Grier HE, Granowetter L, Womer RB, Meyers PA, Felgenhauer J, Marina N, DuBois SG. Identification of Discrete Prognostic Groups in Ewing Sarcoma. Pediatr Blood Cancer 2016; 63:47-53. [PMID: 26257296 PMCID: PMC5011751 DOI: 10.1002/pbc.25709] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 07/20/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although multiple prognostic variables have been proposed for Ewing sarcoma (EWS), little work has been done to further categorize these variables into prognostic groups for risk classification. PROCEDURE We derived initial prognostic groups from 2,124 patients with EWS in the SEER database. We constructed a multivariable recursive partitioning model of overall survival using the following covariates: age; stage; race/ethnicity; sex; axial primary; pelvic primary; and bone or soft tissue primary. Based on this model, we identified risk groups and estimated 5-year overall survival for each group using Kaplan-Meier methods. We then applied these groups to 1,680 patients enrolled on COG clinical trials. RESULTS A multivariable model identified five prognostic groups with significantly different overall survival: (i) localized, age <18 years, non-pelvic primary; (ii) localized, age <18, pelvic primary or localized, age ≥18, white, non-Hispanic; (iii) localized, age ≥18, all races/ethnicities other than white, non-Hispanic; (iv) metastatic, age <18; and (v) metastatic, age ≥18. These five groups were applied to the COG dataset and showed significantly different overall and event-free survival based upon this classification system (P < 0.0001). A sub-analysis of COG patients treated with ifosfamide and etoposide as a component of therapy evaluated these findings in patients receiving contemporary therapy. CONCLUSIONS Recursive partitioning analysis yields discrete prognostic groups in EWS that provide valuable information for patients and clinicians in determining an individual patient's risk of death. These groups may enable future clinical trials to adjust EWS treatment according to individualized risk.
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Affiliation(s)
- Erin E. Karski
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Elizabeth Mcilvaine
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, CA
| | - Mark R. Segal
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mark Krailo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, CA
| | - Holcombe E. Grier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Linda Granowetter
- Department of Pediatrics, New York University Langone Medical Center, NY, NY
| | - Richard B. Womer
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Paul A. Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, NY, NY
| | - Judy Felgenhauer
- Department of Pediatrics, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA
| | - Neyssa Marina
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Steven G. DuBois
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA
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Extraosseous Ewing Sarcoma: Diagnosis, Prognosis and Optimal Management. Indian J Surg 2015; 78:49-53. [PMID: 27186040 DOI: 10.1007/s12262-015-1399-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
Extraosseous Ewing sarcomas (EESs) are rare tumours originating from soft tissues. Their clinical picture depends mainly on the primary site of the sarcoma. Patient characteristics and outcomes seem to be different in EES compared to patients with skeletal Ewing sarcoma, with implications for patient care and prognosis. However, multimodality therapeutic strategies are recommended for all types of the Ewing tumour family. The available diagnostic tools include ultrasonographic evaluation and computed tomography (CT) or magnetic resonance imaging as well as histopathologic and immunohistochemical tissue examination. Several histologic and genetic biomarkers have been established, although their utilization needs to be further tested by larger prospective studies. Regarding localized disease, the recommended treatment remains surgery. However, chemotherapy can be added to achieve improved survival, with neoadjuvant regimens showing more promising results than adjuvant regimens. Radiotherapy is an option to obtain local control, although its complications have reduced its utilization. In metastatic or recurrent disease, systematic chemotherapy improves survival.
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Monument MJ, Grossmann AH, Baker CC, Randall RL, Liu T, Albertson DJ. Molecular Confirmation of Ewing Sarcoma in an 85-Year-Old Woman. Int J Surg Pathol 2015; 23:500-4. [PMID: 26116579 DOI: 10.1177/1066896915591584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of a Ewing sarcoma/primitive neuroectodermal tumor in an 85-year-old woman who presented with an enlarging circumscribed left flank mass. Magnetic resonance imaging revealed a 3 × 5 × 10 cm heterogeneous mass arising from the 10th rib. Computed tomography demonstrated a small nodule in the right middle lobe and bilateral pleural effusions. The patient underwent computed tomography-guided biopsy followed by open biopsy. The tumor cells were characterized by loosely cohesive sheets of tumor cells with uniform nuclei, and scant, granular, eosinophilic cytoplasm with indistinct cell membranes. Frequent mitoses, apoptosis, and necrosis were present. The cells were positive for CD99 with a strong concentric staining pattern. Epithelial, hematopoietic, and neural markers were all negative. Fluorescence in situ hybridization was performed and demonstrated EWSR1 (22q12) gene rearrangement. Sanger sequencing of the reverse transcriptase polymerase chain reaction product from the patient's tumor demonstrated the EWSR1-FLI1 type 1 fusion. Following diagnosis the patient elected to proceed with localized radiation and declined chemotherapy. She developed progressive lung disease and subsequently died of her disease a year after her initial diagnosis. Ewing sarcoma is predominantly a pediatric disease and uncommon in patients older than 40 years of age. To the best of our knowledge, this is the oldest documented case of Ewing sarcoma, diagnosed using modern molecular techniques.
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Affiliation(s)
| | - Allie H Grossmann
- University of Utah, Salt Lake City, UT, USA ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Christine C Baker
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | | | - Ting Liu
- University of Utah, Salt Lake City, UT, USA ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Daniel J Albertson
- University of Utah, Salt Lake City, UT, USA ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
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Casey DL, Meyers PA, Alektiar KM, Magnan H, Healey JH, Boland PJ, Wolden SL. Ewing sarcoma in adults treated with modern radiotherapy techniques. Radiother Oncol 2014; 113:248-53. [PMID: 25613397 DOI: 10.1016/j.radonc.2014.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate local control and survival outcomes in adults with Ewing sarcoma (ES) treated with radiotherapy (RT). MATERIAL AND METHODS Retrospective review of all 109 patients age ⩾18 treated for ES with RT to the primary site at Memorial Sloan Kettering Cancer Center between 1990 and 2011. RT was used as the definitive local control modality in 44% of patients, preoperatively for 6%, and postoperatively for 50%. RESULTS Median age at diagnosis was 27years (range, 18-67). The 5-year local failure (LF) was 18%. Differences in LF were not identified when evaluated by modality of local control (RT versus combined surgery and RT), RT dose, fractionation, and RT technique. However, margin status at time of resection significantly predicted LF. The 5-year event-free survival and overall survival rates were 44% and 66% for patients with localized disease, compared with 16% and 26% for metastatic disease (p=0.0005 and 0.0002). Tumor size, histopathologic response to chemotherapy, and treatment on or according to a protocol were also significantly associated with survival. CONCLUSIONS This series of adults treated with modern chemotherapy and RT had prognostic factors and outcomes similar to adolescents with ES. All adults with ES should be treated with an aggressive, multidisciplinary approach.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Paul A Meyers
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Heather Magnan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - John H Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Patrick J Boland
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
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Dhua AK, Bharathi R, Kiran CM, Lingam PP, Joshi M. Extra-osseous Ewing's sarcoma of sciatic nerve masquerading as an infected hemangioma: A rare case report. J Indian Assoc Pediatr Surg 2014; 19:230-2. [PMID: 25336807 PMCID: PMC4204250 DOI: 10.4103/0971-9261.142016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Extra-osseous Ewing's Sarcoma (EES) arising from the peripheral nerve is rarely reported in children. Here, we report an instance of EES arising from the left sciatic nerve mimicking an infected hemangioma. This case highlights the need for a high index of suspicion and early histological diagnosis to avoid diagnostic delay.
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Affiliation(s)
- Anjan K Dhua
- Department of Pediatric Surgery, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Ravindhra Bharathi
- Department of Pediatric Surgery, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Chokka Mahesh Kiran
- Department of Pathology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Pappu Paramartha Lingam
- Department of Plastic Surgery, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | - Manoj Joshi
- Department of Pediatric Surgery, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
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Abstract
Ewing's sarcoma is the second most common bone malignancy in children, but is extremely rare in adults. The outcome of patients with localized disease has improved over the past decades due to better combination chemotherapies, and better methods of local control. Unfortunately, patients with metastatic disease have a very poor outcome with current antineoplastic therapies. In this article, we will review the primary treatment for adult patients with Ewing's sarcoma, both for localized and metastatic disease. The prognostic factors in adult patients with EWS will also be reviewed.
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Blas JVV, Smith ML, Wasif N, Cook CB, Schlinkert RT. Ewing sarcoma of the adrenal gland: a rare entity. BMJ Case Rep 2013; 2013:bcr2012007753. [PMID: 23853184 PMCID: PMC3736389 DOI: 10.1136/bcr-2012-007753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old man was referred to our office with an enlarging left adrenal mass found on work-up for prostate cancer. Imaging performed over the course of 6 months demonstrated an increasing left adrenal mass from 2.8 to 3.6 cm. Functional testing of the adrenal lesion was performed. The adrenal mass was non-functional. Owing to the enlarging size, the patient underwent a laparoscopic left adrenalectomy without complication and was discharged home the following day. Gross pathological evaluation demonstrated a 3.2 cm, well-encapsulated, partially cystic mass. Histological evaluation demonstrated a small round blue cell tumour suspicious of sarcoma. Immunohistochemical testing revealed strong CD99 positivity consistent with Ewing family of tumours. Reverse transcriptase PCR demonstrated the presence of the Ewing sarcoma fusion transcript. The patient is currently enrolled in an ongoing research chemotherapy protocol at our institution using vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide.
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Koohbanani B, Han G, Reed D, Zhao Q, Yi D, Henderson-Jackson E, Bui MM. Ethnicity and age disparities in Ewing sarcoma outcome. Fetal Pediatr Pathol 2013; 32:246-52. [PMID: 23043418 DOI: 10.3109/15513815.2012.721480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This institutional retrospective review studied Ewing sarcomas from 1987-2011. Among 135 patients, 127 (19 Hispanic and 108 white/non-Hispanic) were analyzed (excluding small sample sized groups) finding 15% Hispanic, 85% non-Hispanic, 27% <18 years, 21% >40 years and 1-272 months follow-up (median 41). Age was significantly associated with overall survival (OS) (p = 0.01), whereby <18 years had a higher probability of 5-year survival (OS 61%) than >40 years (OS 37.6%). Ethnicity was marginally statistically significant (OS, p = 0.065); whereby median survival was clinically significant (white non-Hispanic 63 months and Hispanic 23 months). Hispanic ethnicity and older age are independent poor prognostic factors.
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Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the Radiologic Pathology Archives: Ewing Sarcoma Family of Tumors: Radiologic-Pathologic Correlation. Radiographics 2013; 33:803-31. [DOI: 10.1148/rg.333135005] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Gorelik N, Dickson BC, Wunder JS, Bleakney R. Ewing's sarcoma of the patella. Skeletal Radiol 2013; 42:729-33. [PMID: 23381466 DOI: 10.1007/s00256-013-1580-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/02/2013] [Accepted: 01/13/2013] [Indexed: 02/02/2023]
Abstract
Ewing's sarcoma is a relatively rare malignancy, occurring mainly between 4 and 25 years of age. It usually arises from the pelvis, followed by the femur, tibia, and remainder of both the long bones of the extremities and flat bones of the axial skeleton. To the best of our knowledge, Ewing's sarcoma of the patella has never been reported previously. Patellar tumors occur infrequently and represent an uncommon etiology of anterior knee pain. We describe the rare case of a 41-year-old man who presented with a 3-4 month history of escalating right anterior knee pain and swelling. Imaging demonstrated an aggressive patellar tumor with an adjacent soft tissue mass. The diagnosis of Ewing's sarcoma was confirmed by pathology. Physicians should be aware of atypical locations for Ewing's sarcoma and, conversely, of rare tumors arising in the patella and accounting for anterior knee pain. Early recognition of such malignancies allows prompt initiation of treatment, hence improving prognosis.
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Affiliation(s)
- Natalia Gorelik
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
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Karski EE, Matthay KK, Neuhaus JM, Goldsby RE, Dubois SG. Characteristics and outcomes of patients with Ewing sarcoma over 40 years of age at diagnosis. Cancer Epidemiol 2012; 37:29-33. [PMID: 22959474 DOI: 10.1016/j.canep.2012.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/08/2012] [Accepted: 08/12/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND The peak incidence of Ewing sarcoma (EWS) is in adolescence, with little known about patients who are ≥40 years at diagnosis. We describe the clinical characteristics and survival of this rare group. METHODS This retrospective cohort study utilized the Surveillance Epidemiology and End Results database. 2780 patients were identified; including 383 patients diagnosed ≥40 years. Patient characteristics between age groups were compared using chi-squared tests. Survival from diagnosis to death was estimated via Kaplan-Meier methods, compared with log-rank tests, and modeled using multivariable Cox methods. A competing risks analysis was performed to evaluate death due to cancer. RESULTS Patients ≥40 years of age were more likely to have extra-skeletal tumors (66.1% vs. 31.7%; p < 0.001), axial tumors (64.0% vs. 57.2%; p = 0.01), and metastatic disease at diagnosis (35.5% vs. 30.0%; p = 0.04) compared to younger patients. Five-year survival for those age ≥40 and age <40 were 40.6% and 54.3%, respectively (p < 0.0001). A Cox multivariable model controlling for differences between groups confirmed inferior survival for older patients (hazard ratio for death of 2.04; 95% CI 1.63-2.54; p < 0.0001); though treatment data were unavailable and not controlled for in the model. A competing risks analysis confirmed increased risk of cancer-related death in older patients. CONCLUSION Patients ≥40 years at diagnosis with EWS are more likely to have extra-skeletal tumors, metastatic disease, and axial primary tumors suggesting a difference in tumor biology. Independent of differences in these characteristics, older patients also have a lower survival rate.
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Affiliation(s)
- Erin E Karski
- Department of Pediatrics, UCSF School of Medicine, San Francisco, CA 94143-0106, USA.
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Khaliq W, Bahador MF, Laurence TN, Sapiente RA, Lewis JS, Graham DL. Ewing's sarcoma: A case report of a 52-year-old woman with recurrent tumor and literature review. Oncol Lett 2011; 3:155-158. [PMID: 22740872 DOI: 10.3892/ol.2011.440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 09/26/2011] [Indexed: 11/06/2022] Open
Abstract
Ewing's sarcoma is the second most common primary sacral tumor. Ewing's sarcomas are rare, aggressive tumors with a tendency towards recurrence following resection and early metastasis. Although peak incidences are between the ages of 10 and 20 years, patients of younger or older age account for almost 30% of the cases. We report the case of a 52-year-old healthy female who presented with a 2-week history of pain in her right posterior thigh that was unable to be relieved by non-steroidal anti-inflammatory medicine and physical therapy. Magnetic resonance imaging demonstrated an irregular right presacral mass and core needle biopsy revealed a small, round blue cell neoplasm. Staging workup was normal and an open biopsy was positive for the ES translocation (22q12). The patient was treated with 17 cycles of vincristine, adriamycin and cytoxan with mesna rescue, alternating with ifosfamide and etoposide in addition to external beam radiation. Post-treatment imaging demonstrated complete resolution of the tumor. Six weeks post-treatment the patient presented with a recurrent tumor. This case emphasizes the importance of timely establishment of initial diagnosis, early metastasis in treatment responsive patients and under-utilization of positron emission tomography-computed tomography (PET-CT) during the treatment to detect sub-clinical metastasis.
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Affiliation(s)
- Waseem Khaliq
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Kaidar-Person O, Haim N, Bar-Sela G. Treatment of adult patients with Ewing’s sarcoma: compliance with chemotherapy protocols & toxicity. Med Oncol 2010; 28 Suppl 1:S685-9. [DOI: 10.1007/s12032-010-9743-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 11/04/2010] [Indexed: 11/28/2022]
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Ewing sarcoma mimicking a peripheral nerve sheath tumor. J Clin Neurosci 2010; 17:1317-9. [DOI: 10.1016/j.jocn.2010.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 02/27/2010] [Indexed: 11/17/2022]
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Chen W, Zhu H, Zhang L, Li K, Su H, Jin C, Zhou K, Bai J, Wu F, Wang Z. Primary Bone Malignancy: Effective Treatment with High-Intensity Focused Ultrasound Ablation. Radiology 2010; 255:967-78. [DOI: 10.1148/radiol.10090374] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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Krikelis D, Judson I. Role of chemotherapy in the management of soft tissue sarcomas. Expert Rev Anticancer Ther 2010; 10:249-60. [PMID: 20132000 DOI: 10.1586/era.09.176] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Soft tissue sarcomas are a diverse group of rare tumors that comprise 1% of all cancers. Few randomized trials of chemotherapy have been performed but there is a clear role for agents such as doxorubicin and ifosfamide in the palliation of advanced disease. There is uncertainty as to whether sequential single-agent treatment is equivalent to combination chemotherapy. For the majority of histological subtypes adjuvant chemotherapy is not of proven value, although there may be situations where it is advantageous. However, there are other subtypes, such as the Ewing's sarcoma family tumors, for which chemotherapy is an essential part of primary management and has definitely improved survival. Apart from Ewing's sarcoma family tumor and rhabdomyosarcoma, there is increasing specialization of chemotherapy according to histological subtype, such as the use of taxanes for angiosarcoma, gemcitabine and docetaxel for leiomyosarcoma, and trabectedin for leiomyosarcoma and liposarcoma, especially the myxoid/round cell variant. Nevertheless, there are serious limitations to existing treatment and novel therapies need to be developed.
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Affiliation(s)
- Dimitrios Krikelis
- University Hospital of Ioannina, Stavros Niarchos Avenue, 45500, Ioannina, Greece.
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Hsieh PC, Li KW, Sciubba DM, Suk I, Wolinsky JP, Gokaslan ZL. Posterior-Only Approach For Total En Bloc Spondylectomy For Malignant Primary Spinal Neoplasms: Anatomic Considerations and Operative Nuances. Oper Neurosurg (Hagerstown) 2009; 65:173-81; discussion 181. [DOI: 10.1227/01.neu.0000345630.47344.17] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
MALIGNANT PRIMARY SPINAL tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. Total en bloc spondylectomy involves removal of vertebral segment(s) in whole to achieve wide tumor excision. Total en bloc spondylectomy can be performed through staged or combined anterior and posterior approaches, or from a posterior-only approach. The posterior-only approach offers the advantage of achieving complete tumor excision and circumferential spinal reconstruction in a single setting. In this report, we discuss the operative management of malignant primary vertebral tumors using the posterior-only approach for total en bloc spondylectomy. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.
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Affiliation(s)
- Patrick C. Hsieh
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Khan W. Li
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian Suk
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Subbiah V, Anderson P, Lazar AJ, Burdett E, Raymond K, Ludwig JA. Ewing’s Sarcoma: Standard and Experimental Treatment Options. Curr Treat Options Oncol 2009; 10:126-40. [PMID: 19533369 DOI: 10.1007/s11864-009-0104-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 04/21/2009] [Indexed: 12/21/2022]
MESH Headings
- Adolescent
- Adult
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/drug therapy
- Bone Neoplasms/radiotherapy
- Bone Neoplasms/surgery
- Child
- Clinical Trials as Topic
- Combined Modality Therapy
- Drug Delivery Systems
- Drug Screening Assays, Antitumor
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/secondary
- Lung Neoplasms/surgery
- Multicenter Studies as Topic
- Oncogene Proteins, Fusion/antagonists & inhibitors
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Protein c-fli-1
- RNA-Binding Protein EWS
- Receptor, IGF Type 1/antagonists & inhibitors
- Sarcoma, Ewing/drug therapy
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/radiotherapy
- Sarcoma, Ewing/secondary
- Sarcoma, Ewing/surgery
- Survival Rate
- Therapies, Investigational
- Transcription Factors/antagonists & inhibitors
- Translocation, Genetic
- Young Adult
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Affiliation(s)
- Vivek Subbiah
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, Labortory of Sarcoma Molecular Therapeutics, M.D. Anderson Cancer Center, Houston, TX, USA
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Scotlandi K, Remondini D, Castellani G, Manara MC, Nardi F, Cantiani L, Francesconi M, Mercuri M, Caccuri AM, Serra M, Knuutila S, Picci P. Overcoming Resistance to Conventional Drugs in Ewing Sarcoma and Identification of Molecular Predictors of Outcome. J Clin Oncol 2009; 27:2209-16. [DOI: 10.1200/jco.2008.19.2542] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The improvement of Ewing sarcoma (EWS) therapy is currently linked to the discovery of strategies to select patients with poor and good prognosis and of modified treatment regimens. In this study, we analyzed the molecular factors governing EWS response to chemotherapy to identify genetic signatures to be used for risk-adapted therapy. Patients and Methods Microarray technology was used for profiling 30 primary tumors and seven metastases of patients who were classified according to event-free survival. For selected genes, real-time polymerase chain reaction was applied in 42 EWS primary tumors as validation assay. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide test was used to evaluate in vitro drug sensitivity. Results We identified molecular signatures that reflect tumor resistance to chemotherapy. Annotation analysis was applied to reveal the biologic functions that critically influenced clinical outcome. The prognostic relevance of glutathione metabolism pathway was validated. The expression of MGST1, the microsomal glutathione S-transferase (GST), was found to clearly predict EWS prognosis. MGST1 expression was associated with doxorubicin chemosensitivity. This prompted us to assess the in vitro effectiveness of 6-(7-nitro-2,1,3-benzoxadiazol-4-ylthio)hexanol (NBDHEX), a new anticancer agent that efficiently inhibits GST enzymes. Six cell lines were found to be sensitive to this new drug. Conclusion Classification of EWS patients into high- and low-risk groups is feasible with restricted molecular signatures that may have practical value at diagnosis for selecting patients with EWS who are unresponsive to current treatments. Glutathione metabolism pathway emerged as one of the most significantly altered prognosis-associated pathway. NBDHEX is proposed as a new potential therapeutic possibility.
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Affiliation(s)
- Katia Scotlandi
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Daniel Remondini
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Gastone Castellani
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Maria Cristina Manara
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Filippo Nardi
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Lara Cantiani
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mirko Francesconi
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mario Mercuri
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Anna Maria Caccuri
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Massimo Serra
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Sakari Knuutila
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Piero Picci
- From the Department of Oncology, Orthopaedic Institute Rizzoli; Department of Veterinary Morphophysiology and Animal Production and Department of Physics, University of Bologna, Bologna; Department of Science and Chemical Technologies, Università Tor Vergata, Roma, Italy; and Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Miller ME, Emerson L, Clayton F, Bentz BG, Data RE, Salzman KL, Smith LM, Yu MK. Extraosseous Ewing's Sarcoma. J Clin Oncol 2007; 25:4845-8. [DOI: 10.1200/jco.2007.13.0930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mark E. Miller
- Department of Pathology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Lyska Emerson
- Department of Pathology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Frederic Clayton
- Department of Pathology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Brandon G. Bentz
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Karen L. Salzman
- Department of Radiology, University of Utah, School of Medicine, Salt Lake City, UT
| | - Lynn M. Smith
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Margaret K. Yu
- Department of Internal Medicine, Division of Hematology and Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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