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Wu Y, Ji H, Zhang S, Zhang Y, Chu W, Mei Y, Niu W, Zhang B. Primary primitive neuroectodermal tumor of urinary bladder: a case report and literature review. Transl Cancer Res 2022; 10:4997-5004. [PMID: 35116350 PMCID: PMC8797345 DOI: 10.21037/tcr-21-864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022]
Abstract
Primary primitive neuroectodermal tumor (PNET) of the bladder is an extremely rare and highly aggressive neoplasm. We report a case of PNET of the urinary bladder associated with increased serum neuron-specific enolase (NSE) in the presence of relapse and metastasis. A 66-year-old male presented to our department due to painless gross hematuria. Computed tomographic urography (CTU) showed an intraluminal tumor in the anterior bladder wall. Biopsy revealed a malignant small round blue cell tumor. The patient denied radical cystectomy, and partial cystectomy was given together with resection of adjacent peritoneum. The patient was diagnosed with primary bladder PNET after pathological inspection with negative surgical margins. Additionally, he received 6 cycles of chemotherapy using etoposide and cisplatin (EP) regime, and showed recurrence and metastasis afterwards. Disease progression was seen after transurethral resection (TUR) of bladder tumor and radiotherapy. Pelvic and retroperitoneal metastasis triggered bilateral hydronephrosis, and then palliative treatment was given with bilateral percutaneous nephrostomy. Finally, he died 12 months after diagnosis. PNETs are highly aggressive tumors characterized by the expression of MIC2 and neural markers and the presence of EWS-FLI1 translocation. We recommend histologic, immunohistochemical, and cytogenetic analysis in all patients with small round blue cell bladder malignancy in order to rule out other small cell malignancies. Multimodal treatment, including surgery and adjuvant chemotherapy must be initiated. Patients aged ≤30 years underwent complete resection of tumor and standard chemotherapy showed a better prognosis, while those with metastasis, incomplete resection and inadequate response to chemotherapy showed poor prognosis. Moreover, an elevated NSE may indicate a poor prognosis.
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Affiliation(s)
- Yuhai Wu
- Department of Urology, Binzhou Medical University Hospital, Binzhou, China
| | - Hong Ji
- Department of Pathology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Shudong Zhang
- Department of Psychology, Binzhou Medical University Hospital, Binzhou, China
| | - Yangyang Zhang
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Chu
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou, China
| | - Wenjie Niu
- Department of Urology, Binzhou Medical University Hospital, Binzhou, China
| | - Bing Zhang
- Department of Urology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Krakorova DA, Halamkova J, Tucek S, Bilek O, Kristek J, Kazda T, Zambo IS, Demlova R, Kiss I. Penis as a primary site of an extraskeletal Ewing sarcoma: A case report. Medicine (Baltimore) 2021; 100:e25074. [PMID: 33725983 PMCID: PMC7982170 DOI: 10.1097/md.0000000000025074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The Ewing sarcoma family of malignant tumors is a group of tumors characterized by morphologically similar round-cell neoplasms and by the presence of a common chromosomal translocation; Ewing sarcoma family of tumors typically occur in children and young adults between 4 to 15 years of age. The primary tumor usually originates in the bone, extraskeletal localization is rare. PATIENT CONCERN We present a case report concerning a 32-year-old male patient with a primary involvement of the penis. DIAGNOSIS The histopathology from the first penile biopsy showed a small-cell neuroendocrine carcinoma; however, that result was based on a sample obtained at a different facility than the Sarcoma Center, where the investigating pathologist did not have the adequate expertise. The patient then underwent a radical penectomy and a second reading of the histology was demanded after a radical penile amputation when Ewing sarcoma with R1 resection was confirmed. INTERVENTIONS The patient was referred to the national Sarcoma Center, where - using a multidisciplinary approach - the treatment was started with curative intent. However, it was preceded by a non-standard initiation of the therapy due to the poor primary diagnosis. OUTCOMES The non-standard therapy at the onset of the disease caused a poor prognosis of an otherwise curable diagnosis. Despite all that, the patient survived for a relatively long time. LESSONS The treatment of sarcomas with atypical localizations should be conducted by an experienced multidisciplinary team in a center with experience in sarcoma treatment.
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Affiliation(s)
| | - Jana Halamkova
- Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Zluty kopec 7, 656 53 Brno, Czech Republic And Department of Medical Ethics, Faculty of Medicine Masaryk University, Kamenice 25
| | - Stepan Tucek
- Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Zluty kopec 7
| | - Ondrej Bilek
- Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Zluty kopec 7
| | - Jan Kristek
- Department of Radiology, Masaryk Memorial Cancer Institute Zluty kopec 7
| | - Tomas Kazda
- Assoc. Prof. Department of Radiation Oncology Masaryk Memorial Cancer Institute Faculty of Medicine Masaryk University Zluty kopec 7
| | - Iva Staniczkova Zambo
- Department of Pathology, St. Anne's University Hospital, Faculty of Medicine Masaryk University Pekarska 53
| | - Regina Demlova
- Assoc. Prof. Clinical Trial Unit, Masaryk Memorial Cancer Institute Zluty kopec 7, 656 53 Brno, Czech Republic And Department of Pharmacology, Faculty of Medicine Masaryk University, Kamenice 25
| | - Igor Kiss
- Assoc. Prof. Department of Cancer Comprehensive Care Masaryk Memorial Cancer Institute Faculty of Medicine Masaryk University Zluty kopec 7, Brno, Czech Republic
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Gao L, Xie W, Li K, Huang G, Ji Y, Ou Y, Chen J. Primitive neuroectodermal tumor of urinary bladder: A case report and literature review. Medicine (Baltimore) 2020; 99:e23032. [PMID: 33157954 PMCID: PMC7647600 DOI: 10.1097/md.0000000000023032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Primitive neuroectodermal tumor (PNET) of the urinary bladder is a highly aggressive tumor with high local recurrence and distant metastasis rates in cases of incomplete excision. We report a case of a young female patient, in whom early laparoscopic radical cystectomy combined with standard lymph node dissection and a modified vincristine, doxorubicin hydrochloride, and cyclophosphamide (VAC) chemotherapy regimen was controversial. Because PNET of the urinary bladder is a rare malignancy, the standard treatment regimen has not yet been established. It is not clear whether surgery combined with postoperative chemotherapy for PNET patients may be superior to surgery alone on long term survival. PATIENT CONCERNS The patient was a 45-year-old Chinese woman who complained of lower urinary tract symptoms, including urgency, frequency, and difficulty in urination, for 2 months. DIAGNOSES PNET. INTERVENTIONS The patient underwent laparoscopic radical cystectomy and standard lymph node dissection, combined with modified VAC chemotherapy regimens. OUTCOMES After undergoing radical surgery in 2018, the patient completed 6 courses of adjuvant chemotherapy. Abdominal and thorax computed tomography scanning was performed 3, 6, 9, and 12 months after the surgery was completely free of tumor. The patient is still alive with no signs of recurrent disease 2 years after diagnosis. LESSONS Radical surgery and standard lymphadenectomy combined with adjuvant chemotherapy may be essential to improve the prognosis of PNET of the urinary bladder.
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Affiliation(s)
- Liang Gao
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
| | - Wenjie Xie
- Department of Urology, the First Affiliated Hospital of Nanchang University
| | - Kun Li
- Department of Urology, Jiujiang No.1 People's Hospital
| | - Gaomin Huang
- Department of Urology, the First Affiliated Hospital of Nanchang University
| | - Yuanhai Ji
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
| | - Yangkang Ou
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
| | - Jie Chen
- Department of Urology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University
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Abstract
RATIONALE A primary primitive neuroectodermal tumor (PNET) is a rare and highly malignant tumor that often occurs in the central nervous system of children and young adults. This tumor is rarely observed in the bladder. PATIENT CONCERNS In this paper, we describe the case of a 64-year-old man with a PNET of the bladder. He experienced dull pain in the lower left abdomen for 5 months (without any obvious inducement), which gradually became aggravated and intolerable. DIAGNOSES Partial cystectomy was performed, and a PNET of the bladder, which is extremely rare, was confirmed. INTERVENTIONS Following cystectomy, the patient's general postoperative state was poor and he could not tolerate chemotherapy. Thus, he was subjected to pelvic radiotherapy for 2 weeks. OUTCOMES His physical condition did not improve significantly after radiotherapy; however, we still plan to continue it. If the patient's physical condition improves, chemotherapy will be considered. LESSONS Most cases of PNETs are intravesical or at least mainly endophytic. However, in this case, the mucosal layer was barely involved, and the tumor mainly grew out of the bladder, which is very rare. The present case provides reference for the diagnosis of PNET.
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Affiliation(s)
| | - Dian-Jun Qi
- Department of General Practice, the First Affiliated Hospital of China Medical University
| | - Qing-Fu Zhang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences of China Medical University, Shenyang, PR China
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Baisakh MR, Tiwari A, Gandhi JS, Naik S, Sharma SK, Balzer BL, Sharma S, Peddinti K, Jha S, Sahu PK, Pradhan D, Geller M, Amin MB, Dhillon J, Mohanty SK. Primary round cell sarcomas of the urinary bladder with EWSR1 rearrangement: a multi-institutional study of thirteen cases with a review of the literature. Hum Pathol 2020; 104:84-95. [PMID: 32798549 DOI: 10.1016/j.humpath.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
Primary Ewing sarcoma (ES) of the urinary bladder is a rare and aggressive small blue round cell malignant neoplasm associated primarily with translocation involving EWSR1 and FLI1 genes located in the 22nd and 11th chromosomes, respectively. To date, 18 cases have been published in the literature as single-case reports, based chiefly on CD99 positivity (17 patients). Molecular confirmation by fluorescence in situ hybridization was performed in 9 patients, and FLI1 immunohistochemical (IHC) analysis was not performed in any of these published cases. Herein, we present thirteen patients of more comprehensive primary round cell sarcomas of the urinary bladder with EWSR1 rearrangement. Clinicopathologic parameters including demographics; clinical presentation; histopathologic, IHC, and molecular profiles; and management and follow-up data of 13 patients with primary round cell sarcomas with EWSR1 rearrangement (Ewing family of tumor) of the urinary bladder were analyzed. The studied patients (n = 13) included 6 females and 7 males; their age ranged from 4 years to 81 years (median = 30 years). The most common clinical presentation was hematuria (n = 7), followed by hydronephrosis (n = 2, one with renal failure). The tumor size ranged from 2.9 cm to 15 cm in maximum dimension. Conventional ES architecture and histology was observed in 6 cases, and diverse histology was observed in 7 cases (adamantinomatous pattern [n = 1], alveolar pattern [n = 1], ganglioneuroblastoma-like pattern [n = 2], and small cell carcinoma-like pattern [n = 3]). All the tumors were muscle invasive (invasion into the muscularis propria). IHC analysis showed that all tumors expressed FLI1, CD99, and at least one neuroendocrine marker. Focal cytokeratin staining was positive in 2 patients, and RB1 was retained in all patients. EWSR1 rearrangement was seen in 12 of 12 tumors (in 12 patients) tested. A combined multimodal approach that included surgery with chemotherapy was instituted in all patients. Follow-up was available for 11 patients (ranging from 5 to 24 months). Six patients either died of disease (n = 3) or other causes (n = 3). Five patients were alive with metastases to the liver (n = 1), liver and lung (n = 2), liver and abdominal wall (n = 1), and kidney (n = 1). Based on our experience with the largest series to date and aggregate of the published data, ES/round cell sarcomas with EWSR1 rearrangement occurring in the bladder have bimodal age distribution with poor prognosis despite aggressive therapy. Owing to its rarity and age distribution, the differential diagnosis is wide and requires a systematic approach for ruling out key age-dependent differential diagnoses aided with molecular confirmation.
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Affiliation(s)
- Manas R Baisakh
- Apollo Hospital, Bhubaneswar, 751005, India; Prolife Diagnostics, Bhubaneswar, 751019, India
| | - Ankit Tiwari
- National Institute of Science Education and Research, Bhubaneswar, 752050, India
| | - Jatin S Gandhi
- University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | | | | | | | | | - Kamal Peddinti
- Advanced Medical Research Institute, Bhubaneswar, 751030, India
| | - Shilpy Jha
- All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Pradeepa K Sahu
- Advanced Medical Research Institute, Bhubaneswar, 751030, India
| | - Dinesh Pradhan
- University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Matthew Geller
- Washington County Pathologists, PC Hillsboro, OR, 97123, USA
| | - Mahul B Amin
- University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | | | - Sambit K Mohanty
- Advanced Medical Research Institute, Bhubaneswar, 751030, India; CORE Diagnostics, Gurgaon, 122016, India.
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6
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Ewing sarcoma of urinary bladder occurring simultaneously with high grade papillary urothelial carcinoma. Pathology 2020; 52:612-615. [PMID: 32600659 DOI: 10.1016/j.pathol.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022]
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Murthy SS, Challa S, Raju K, Rajappa SJ, Fonseca D, Gundimeda SD, Rao BV, Ahmed F, Kodandapani S, Nambaru L, Mundada MC, Sharma R, Mallavarapu KM, Koppula VC, Rao TS. Ewing Sarcoma With Emphasis on Extra-skeletal Ewing Sarcoma: A Decade's Experience From a Single Centre in India. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2020; 13:2632010X20970210. [PMID: 33241208 PMCID: PMC7672761 DOI: 10.1177/2632010x20970210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/02/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The diagnosis of Ewing sarcoma family of tumours (ESFT) is challenging, especially in adults and in extra-skeletal or visceral location. Several morphologic mimics with varied treatment options and prognosis confer diagnostic dilemmas. Application of ancillary diagnostic modalities in surgical pathology in clinical routine has enabled accurate diagnosis of ESFT in bone, soft tissues, and viscera. AIM The study aims to assess the clinicopathological features including molecular test results of ESFT with emphasis on sex, age, and location, especially extra-skeletal soft tissue and visceral location. MATERIAL AND METHODS Data of clinicopathological, molecular tests (wherever performed), diagnosis rendered in 302 ESFT over a decade from our centre were reviewed. Statistical comparison of skeletal and extra-skeletal tumours with reference to age and sex was done using SPSS package. The P value of <.05 was considered significant. RESULTS The cohort included 302 ESFTs with 49% skeletal and 51% extra-skeletal tumours. Thigh was most common site among skeletal tumours; chest wall, paraspinal location, and retroperitoneum among soft tissues (39.4%); and kidney, ovary, and cervix among visceral tumours (11.3%). Fluorescence in situ hybridisation for EWSR1 gene rearrangement was positive in 54 patients and reverse-transcriptase polymerase chain reaction in 19 patients. Predominance of male sex, younger age and location in extremities among skeletal tumours and lack of gender predilection, higher age and axial location in extra-skeletal tumours were noted, which were statistically significant. Molecular tests were performed more frequently in extra-skeletal tumours, especially in visceral tumours to establish the diagnosis. CONCLUSIONS The study showed statistically significant differences in the age, sex, and location between skeletal and extra-skeletal ESFT. The increased percentage of extra-skeletal tumours especially in viscera was attributed to the increased awareness and availability of ancillary techniques.
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Affiliation(s)
- Sudha S Murthy
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - S Challa
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Kvvn Raju
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - S J Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - D Fonseca
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - S D Gundimeda
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - B V Rao
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - F Ahmed
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - S Kodandapani
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - L Nambaru
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - M C Mundada
- Department of Pathology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - R Sharma
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - K M Mallavarapu
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - V C Koppula
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - T S Rao
- Department of Radiology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
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8
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Ewing's Sarcoma/Primitive Neuroectodermal Tumor Arising from the Adrenal Gland: A Case Report and Literature Review. TUMORI JOURNAL 2018; 99:e104-6. [DOI: 10.1177/030089161309900326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a rare case of Ewing's sarcoma (ES)/primitive neuroectodermal tumor (PNET) arising from the adrenal gland. A 17-year-old Japanese woman presented with left upper abdominal pain and high fever. Computed tomography and magnetic resonance imaging revealed a 15×10 cm tumor replacing the adrenal gland. Preoperative diagnosis was an adrenocortical carcinoma. Resection of the tumor was performed. We obtained the final diagnosis of ES/PNET by immunohistochemical molecular study with positive staining for the MIC2 gene product (CD99) and a Ewing sarcoma breakpoint region 1 (EWSR1) gene rearrangement. Local recurrence was observed one month after the surgery. The patient was then treated with systemic chemotherapy and localized radiotherapy.
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Lam CJ, Shayegan B. Complete resection of a primitive neuroectodermal tumour arising in the bladder of a 31-year-old female after neoadjuvant chemotherapy. Can Urol Assoc J 2016; 10:E264-E267. [PMID: 28255420 DOI: 10.5489/cuaj.3808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primitive neuroectodermal tumours (PNET) that arise in the urinary bladder are an extremely rare occurrence. Very few cases have been reported so far in the literature1-13 and we report another case here in a 31-year-old-female. The patient presented with polyuria, gross hematuria, followed by development of anuria, and was discovered to have a 9.4 cm mass arising in the posterolateral aspect of the bladder. Histologically, the tumour showed small, round, blue cells. Further analysis using break-apart fluorescent in situ hybridization (FISH) revealed non-random chromosomal translocations of the ews gene suggestive of Ewing sarcoma (ES)/PNET. The patient completed seven cycles of neoadjuvant chemotherapy, which significantly reduced the size of the lesion. Due to the location of the lesion, surgical resection of the entire bladder and urethra with use of a continent cutaneous reservoir was performed. Here, the management of a 31-year-old female with ES/PNET arising from the bladder is reported.
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Affiliation(s)
- Cameron J Lam
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, ON, Canada
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10
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Tonyalı Ş, Yazıcı S, Yeşilırmak A, Ergen A. The Ewing's Sarcoma Family of Tumors of Urinary Bladder: A Case Report and Review of the Literature. Balkan Med J 2016; 33:462-6. [PMID: 27606145 PMCID: PMC5001827 DOI: 10.5152/balkanmedj.2016.16533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Only 15 cases of Ewing's Sarcoma (EWS) family of tumors of urinary bladder have been documented in the literature to date. CASE REPORT We presented here a 38 year-old female with primary urinary bladder EWS with no distant metastases. She had presented with macroscopic hematuria and had undergone transurethral resection of the tumor within the following week. Microscopic examination revealed a tumor diffusely infiltrating the lamina propria and muscularis propria under an intact urothelium, which was composed of small round blue cells with scant cytoplasm, monotonous round or oval nuclei, stippled chromatin and small nucleoli. Immunohistochemistry showed strong vimentin, synaptophysin and membranous CD99 expression by the tumor. Fluorescent in situ hybridization analysis displayed the EWSR1 rearrangement. Radical cystectomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy, extended lymph node dissection, and ileal conduit were performed. As adjuvant chemotherapy, she received vincristine, doxorubicin, cyclophosphamide and mesna, alternating with courses of etoposide, iphosphamide and mesna. She is alive and well with no evidence of disease 14 months after the surgery. CONCLUSION Surgery supported with chemotherapy should be considered as an option, especially in advanced Ewing's sarcoma family of tumors of urinary bladder.
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Affiliation(s)
- Şenol Tonyalı
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sertaç Yazıcı
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysun Yeşilırmak
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Ergen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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11
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Esch L, Barski D, Bug R, Otto T. Prostatic sarcoma of the Ewing family in a 33-year-old male - A case report and review of the literature. Asian J Urol 2015; 3:103-106. [PMID: 29264173 PMCID: PMC5730813 DOI: 10.1016/j.ajur.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 01/29/2023] Open
Abstract
Ewing sarcoma is the second most common primary bone tumor seen in children and adolescents, typically presenting between 10 and 20 years of age. Extraosseous sarcomas of the Ewing family in adults are rare. We report a manifestation of this tumor entity in the periprostatic tissue of a 33-year-old male and discuss our treatment approach. Transrectal biopsy is a feasible and simple diagnostic tool for unclear pelvic masses. Multi-modal therapy and central registries are needed to gain knowledge of rare pelvic tumors like Ewing sarcoma.
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Affiliation(s)
- Lukas Esch
- Department of Urology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Dimitri Barski
- Department of Urology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Reinhold Bug
- Department of Pathology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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12
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Vallonthaiel AG, Kaur K, Jain D, Singh G, Tiwari D, Pramanik R, Singh P, Sharma MC. Ewing Sarcoma of Urinary Bladder Showing EWSR1 Rearrangement on FISH Analysis and Unique Response to Chemotherapy. Clin Genitourin Cancer 2015; 14:e183-6. [PMID: 26684812 DOI: 10.1016/j.clgc.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Affiliation(s)
| | - Kavneet Kaur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deviprasad Tiwari
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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13
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Ba L, Tan H, Xiao H, Guan Y, Gao J, Gao X. Radiologic and clinicopathologic findings of peripheral primitive neuroectodermal tumors. Acta Radiol 2015; 56:820-8. [PMID: 25073463 DOI: 10.1177/0284185114539321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 05/19/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primitive neuroectodermal tumors (PNETs) constitute a rare type of malignant neuroectodermal tumors that have chromosomal translocations identical to Ewing's sarcoma (ES), and the characteristics of this disease remain unclear. PURPOSE To describe the clinical, radiological, and pathological features of peripheral PNETs (pPNETs) to enhance their recognition. MATERIAL AND METHODS The clinical, imaging, and pathologic findings of 35 patients with pPNETs were retrospectively reviewed, all being confirmed by biopsy or surgical pathology. All 35 patients had preoperative computed tomography (CT) examinations; 10 patients had preoperative magnetic resonance imaging (MRI) studies. RESULTS Of 35 pPNET patients, 54.3% had a primary tumor in soft tissue, the others in bone. On plain CT images, 33 lesions demonstrated heterogeneous hypodense masses with multiple lamellar lower density, and with osteolytic destruction if the tumor originated in bone. Calcification was only found in five lesions arising in soft tissue. All lesions enhanced heterogeneously with varying areas of cystic changes, and all lesions in bone and 52.6% of lesions in soft tissue showed ill-defined margins after contrast administration. On MRI, these tumors appeared in conjunction with osteolytic bone destruction and irregular soft tissue masses iso- to hypointense to skeletal muscle on T1-weighted images and showed heterogeneously high intensity on T2-weighted images. All lesions enhanced heterogeneously with cystic changes. Homer-Wright rosettes were observed in 15 lesions, and 97.1% lesions were positive for CD99 in histopathological results. CONCLUSION pPNETs can involve any part of the body, and a large, ill-defined, aggressive soft tissue mass and heterogeneous enhancement with or without osteolytic bone destruction on CT or MR images could suggest the diagnosis.
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Affiliation(s)
- Lei Ba
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, PR China
- Department of Radiology, Taizhou Cancer Hospital, Zhejiang, PR China
| | - Hongna Tan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, PR China
| | - Huijuan Xiao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, PR China
| | - Yansheng Guan
- Department of Radiology, Taizhou Cancer Hospital, Zhejiang, PR China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, PR China
| | - Xianzheng Gao
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, PR China
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Successful complete resection of Ewing sarcoma arising from the bladder in a 10-year-old boy after chemotherapy. Pediatr Surg Int 2014; 30:965-9. [PMID: 25080033 DOI: 10.1007/s00383-014-3573-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
Ewing sarcoma (ES) of the bladder is extremely rare. Here we report the successful treatment of the youngest case of ES arising from bladder encountered to date and a literature review. A 10-year-old boy who presented with polyuria and lower abdominal swelling was found to have a 13 cm mass arising from the bladder localized to the center of the lower abdomen. Biopsy confirmed ES. Following chemotherapy, the mass shrank to 5 cm and was found to be localized to the right side of the bladder with invasion of the right vas deferens. One-third of the right side of the bladder and part of the right vas deferens were resected. No viable cancer cells were detected in the resected specimen, and the surgical margins were reported to be negative. The patient is currently well with no recurrence or metastases after 11 months. There are 12 cases of Ewings sarcoma arising from the bladder reported in the English literature; two cases in children. Our case will be the third pediatric case and the youngest.
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15
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Abstract
Mesenchymal tumours of the urinary bladder and prostate are infrequent neoplasms. The body of literature is growing with isolated case reports and short series, and the majority of cases are benign neoplasms. Other than stromal tumour of uncertain malignant potential and prostatic stromal sarcoma, both neoplasms derived from the specific prostatic stroma, the mesenchymal neoplasms in these locations are identical to their counterparts seen in other organs. However, the limited amount of tissue generated by biopsy and rarity of mesenchymal lesions in these sites create unique diagnostic difficulties, while correct classification of the neoplasm often bears significant impact on prognosis and therapeutic strategy. In this review we summarise the diagnostic features, focus on the differential diagnosis, and highlight the potential diagnostic pitfalls of mesenchymal tumours of the bladder and prostate.
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