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Manatakis DK, Tsouknidas I, Mylonakis E, Tasis N, Antonopoulou MI, Acheimastos V, Mastoropoulou A, Korkolis DP. Primary adrenal Ewing sarcoma: A systematic review of the literature. World J Clin Cases 2023; 11:6782-6791. [PMID: 37900999 PMCID: PMC10600854 DOI: 10.12998/wjcc.v11.i28.6782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland. AIM To present a comprehensive review of primary adrenal ES, with emphasis on diagnosis, therapy and oncological outcomes. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. PubMed/ MEDLINE, EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor (PNET) of the adrenal gland. PubMed, Google Scholar and EMBASE medical databases were searched, combining the terms "adrenal", "ES" and "PNET". Demographic, clinical, pathological and oncological data of patients were analyzed by SPSS version 29.0. RESULTS A total of 52 studies were included for review (47 case reports and 5 case series) with 66 patients reported to have primary adrenal ES. Mean age at diagnosis was 26.4 ± 15.4 years (37.9% males, 57.6% females, sex not reported in 3 cases). The most frequent complaint was abdominal/flank pain or discomfort (46.4%) followed by a palpable mass (25.0%), and the average duration of symptoms was 2.6 ± 3.1 mo. The imaging modality of choice was computed tomography scan (81.5%), followed by magnetic resonance imaging (20.4%). Preoperative staging revealed that 17 tumors (27.9%) were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis. Open adrenalectomy was performed in the majority of cases (80.0%), of which 27.9% required more extensive resection. Minimally invasive surgery was attempted in 8.2% of tumors. Complete surgical resection was achieved in 89.4% of the patients. Adjuvant therapy was administered to 32 patients, in the form of chemotherapy (62.5%), radiotherapy (3.1%) or combination (34.4%). Median overall survival was 15 mo and 24-mo overall survival was 40.5%. Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%. CONCLUSION The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes. ES remains an aggressive tumor with a poor prognosis and high mortality.
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Affiliation(s)
| | - Ioannis Tsouknidas
- General Surgery, Lankenau Medical Center, Main Line Health, Wynnewood, PA 19096, United States
| | - Emmanouil Mylonakis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens 11521, Greece
| | - Nikolaos Tasis
- 2nd Department of Surgery, Athens Naval and Veterans Hospital, Athens 11521, Greece
- Department of Surgical Oncology, St Savvas Cancer Hospital, Athens 11522, Greece
| | | | | | | | - Dimitrios P Korkolis
- Department of Surgical Oncology, St Savvas Cancer Hospital, Athens 11522, Greece
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2
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Atagi K, Karashima T, Mizutani K, Fukuhara H, Fukata S, Miura Y, Mitsuishi A, Hanazaki K, Uemura S, Miyazaki R, Anayama T, Yamane M, Sakai M, Iguchi M, Yorita K, Inoue K. Primary adrenal Ewing's sarcoma family of tumors with tumor thrombus of the inferior vena cava: a case report. J Med Case Rep 2023; 17:108. [PMID: 36959631 PMCID: PMC10037830 DOI: 10.1186/s13256-023-03837-w] [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: 11/13/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Ewing's sarcoma is a malignant neoplasm that mainly occurs in skeletal tissue but can rarely arise in soft tissues. Recently, small round cell tumors (including Ewing's sarcoma) caused by chromosomal translocations have been collectively termed Ewing's sarcoma family of tumors. We report a rare case of primary adrenal Ewing's sarcoma family of tumors with tumor thrombus. CASE PRESENTATION A 22-year-old Asian woman was referred to our hospital with a left retroperitoneal tumor 19 cm in diameter. Tumor thrombus was identified from the left adrenal vein to the inferior vena cava, infiltrating the right atrium. Total tumor excision with left adrenalectomy, nephrectomy, and thrombectomy was performed under hypothermic circulatory arrest, followed by seven courses of adjuvant chemotherapy. The patient has shown no signs of recurrence as of 26 months postoperatively. CONCLUSION Radical surgery combined with systemic chemotherapy may contribute to good prognosis in patients with primary adrenal Ewing's sarcoma family of tumors.
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Affiliation(s)
- Kaya Atagi
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan.
- Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan.
| | - Keisuke Mizutani
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Hideo Fukuhara
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Satoshi Fukata
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Digestive Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Sunao Uemura
- Department of Digestive Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Ryohei Miyazaki
- Department of Respirator Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Takashi Anayama
- Department of Respirator Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Mayuka Yamane
- Department of Respiratory Medicine, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Mizu Sakai
- Department of Respiratory Medicine, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Mitsuko Iguchi
- Laboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, 783-8505, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, 780-8562, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
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3
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Roy D, Pereira M, Shivdasani D, Singh N. 18 F-FDG PET-CT Evaluation of Primary Adrenal Ewing Sarcoma with Venous Thrombosis: An Unusual Presentation. World J Nucl Med 2023; 22:26-28. [PMID: 36923977 PMCID: PMC10010853 DOI: 10.1055/s-0042-1757251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Ewing sarcoma (EWS) is primarily an osseous malignancy of childhood and young adults. Extraskeletal occurrence is less frequent and primary adrenal involvement is an even rare presentation. We present such a case of a 7-year-old boy diagnosed with adrenal EWS with associated venous thrombosis and pulmonary embolism detected on 18 F-fluorodeoxyglucose positron emission tomography-computed tomography scan.
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Affiliation(s)
- Debdip Roy
- Department of Nuclear Medicine and Molecular Imaging, P. D. Hinduja National Hospital and MRC, Mahim, Mumbai, Maharashtra, India
| | - Melvika Pereira
- Department of Nuclear Medicine and Molecular Imaging, P. D. Hinduja National Hospital and MRC, Mahim, Mumbai, Maharashtra, India
| | - Divya Shivdasani
- Department of Nuclear Medicine and Molecular Imaging, P. D. Hinduja National Hospital and MRC, Mahim, Mumbai, Maharashtra, India
| | - Natasha Singh
- Department of Nuclear Medicine and Molecular Imaging, P. D. Hinduja National Hospital and MRC, Mahim, Mumbai, Maharashtra, India
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4
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Wang JL, Xu CY, Geng CJ, Liu L, Zhang MZ, Wang H, Xiao RT, Liu L, Zhang G, Ni C, Guo XY. Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus: A case report. World J Clin Cases 2022; 10:643-655. [PMID: 35097090 PMCID: PMC8771399 DOI: 10.12998/wjcc.v10.i2.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/01/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ewing’s sarcoma of the adrenal gland with inferior vena cava (IVC) and right atrium thrombus is extremely rare. Here, we report a case of giant adrenal Ewing’s sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management.
CASE SUMMARY A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months. Enhanced abdominal computed tomography revealed a large retroperitoneal mass (22 cm in diameter), which may have originated from the right adrenal gland and was closely related to the liver. Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle. After preoperative preparation with cardiopulmonary bypass, sufficient blood products, transesophageal echocardiography and multiple monitoring, tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team. Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously. During transfer of the patient to the intensive care unit (ICU), cardiac arrest occurred without external stimulus. Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min. In the ICU, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were provided to maintain cardiac, liver and kidney function. Histopathologic examination confirmed the diagnosis of Ewing’s sarcoma. After postoperative treatments and rehabilitation, the patient was discharged from the urology ward.
CONCLUSION An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare, and its anesthesia and perioperative management have not been reported. Thus, this report provides significant insights in the perioperative management of patients with adrenal Ewing’s sarcoma and IVC tumor thrombus. Intraoperative circulation fluctuations and sudden cardiovascular events are the major challenges during surgery. In addition, postoperative treatments including ECMO and CRRT provide essential support in critically ill patients. Moreover, this case report also highlights the importance of multidisciplinary cooperation during treatment of the disease.
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Affiliation(s)
- Ji-Lian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chuan-Ya Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Jing Geng
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Ming-Zhu Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hua Wang
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Ruo-Tao Xiao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lu Liu
- Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
| | - Geng Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
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5
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Dobrindt EM, Saeger W, Bläker H, Mogl MT, Bahra M, Pratschke J, Rayes N. The challenge to differentiate between sarcoma or adrenal carcinoma—an observational study. Rare Tumors 2021; 13:20363613211057746. [PMID: 34917301 PMCID: PMC8669116 DOI: 10.1177/20363613211057746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Adrenal sarcomas are rare malignant tumors with structural and clinical similarities to sarcomatoid adrenocortical carcinoma. Preoperative diagnosis of tumors of the adrenal gland can be challenging and often misleading thus detaining patients from appropriate oncological strategies. Objective This analysis of a case series evaluated the predictive capability of the primary clinical diagnosis in case of malignancies of the adrenal gland. Methods Thirty two patients were treated from 2009 to 2015 at our clinic and analyzed retrospectively. All patients had computed tomography and/or magnet resonance imaging and a primary histopathological examination at our institution after surgery. Ten questionable cases were surveyed by a reference pathologist. Results Twelve out of 32 diagnoses had to be revised (37.5%). Only 15 out of 24 tumors primarily classified as adrenocortical carcinoma were finally described as primary adrenal cancer. We found two leiomyosarcomas, one liposarcoma, one sarcomatoid adrenocortical carcinoma, and one epitheloid angiosarcoma among 12 misleading diagnoses. Other tumors turned out to be metastases of lung, hepatocellular, and neuroendocrine tumors. Larger tumors were significantly more often correctly diagnosed compared to smaller tumors. Four patients of the group of revised diagnoses died whereas all patients with confirmed diagnoses survived during the follow-up. Conclusion Preoperative assessment of tumors of the adrenal gland is still challenging. In case of wrong primary diagnosis, the prognosis could be impaired due to inadequate surgical procedures or insufficient preoperative oncological treatment.
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Affiliation(s)
- Eva M Dobrindt
- Department of Surgery, Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfgang Saeger
- Institute of Pathology, University of Hamburg, Hamburg, Germany
| | - Hendrik Bläker
- Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - Martina T Mogl
- Department of Surgery, Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nada Rayes
- Department of Surgery, Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of General, Visceral, Thoracic and Transplant Surgery, University of Leipzig, Leipzig, Germany
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6
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Abstract
Secondary involvement of inferior vena cava is a common presentation in aggressive solid malignancies, especially arising from kidneys, adrenals, and hepatobiliary system, mostly resulting from local infiltration. Rarely, primary tumors are seen arising from vascular tissue. The Ewing family of tumors commonly arises from bone, but there is a high propensity of these tumors to originate from nonosseous sites of mesenchymal cell origin. We would herewith demonstrate a rare presentation of Ewing sarcoma, seen originating from inferior vena cava, presenting as extensive intravascular tumor thrombosis, evaluated on FDG PET/CT imaging in a 12-year-old girl.
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7
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Ibabao C, Tsetse C, Sheth Y, Maitland C, Mohammed M. Primary Ewing sarcoma of the adrenal gland: A rare cause of abdominal mass. Radiol Case Rep 2019; 15:1-6. [PMID: 31737137 PMCID: PMC6849434 DOI: 10.1016/j.radcr.2019.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 01/08/2023] Open
Abstract
Ewing sarcoma is a malignant tumor that more commonly affects the long bones. Primary Ewing sarcoma of the adrenal gland is a rare diagnosis. We report an unusual case of primary Ewing sarcoma of the adrenal gland in a 34-year-old man who initially presented with abdominal as well as flank pain and abdominal mass. Computed tomography and magnetic resonance imaging showed a heterogeneous, hemorrhagic right adrenal mass with inferior vena cava extension and thrombosis. Thus, a major open surgery including right adrenalectomy, right nephrectomy, inferior vena cava thrombectomy with resection, and a retroperitoneal lymph node dissection was necessitated. Early recognition with radiological imaging and treatment of extraosseous Ewing sarcoma of the adrenal gland with a multimodality approach reduces morbidity and mortality.
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Affiliation(s)
| | - Caleb Tsetse
- Department of Radiology, SUNY Upstate University hospital, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Yesha Sheth
- Department of Pathology, SUNY Upstate University hospital, Syracuse, NY, USA
| | - Ceceleta Maitland
- Department of Radiology, SUNY Upstate University hospital, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Mujtaba Mohammed
- Department of Radiology, SUNY Upstate University hospital, 750 East Adams Street, Syracuse, NY, 13210, USA
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8
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Atsumi Y, Saito Y, Hataya H, Fukuzawa R, Yuza Y. Ewing's Sarcoma with Extension into Superior Vena Cava and Right Atrium. Indian J Surg Oncol 2019; 10:98-100. [PMID: 30948882 DOI: 10.1007/s13193-018-0849-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
Ewing sarcoma is rarely shown to develop this intravascular extension so the decision of the initial treatment is more difficult. We report a 7-year-old boy of this sarcoma with extension into superior vena cava (SVC) and right atrium (RA), who was successfully treated with initial surgery. Intravascular extension was observed from the azygous vein to SVC and finally RA. The removal of the intravascular extension was done, 7 days before chemotherapy was started. The initial surgery for the intravascular extension may have decreased a risk of pulmonary tumor embolism and this made the chemotherapy done safe in this patient.
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Affiliation(s)
- Yukari Atsumi
- 1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Yuya Saito
- 2Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Hiroshi Hataya
- 1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Ryuji Fukuzawa
- 3Department of Pathology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
| | - Yuki Yuza
- 2Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu-shi, Tokyo, 083-8561 Japan
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9
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Eddaoualline H, Mazouz K, Rafiq B, El Mghari Tabib G, El Ansari N, Belbaraka R, El Omrani A, Khouchani M. Ewing sarcoma of the adrenal gland: a case report and review of the literature. J Med Case Rep 2018; 12:69. [PMID: 29544549 PMCID: PMC5855992 DOI: 10.1186/s13256-018-1601-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background Ewing sarcoma/primitive neuroectodermal tumor is a family of highly malignant proliferation of neuroectodermal origin, most often skeletal, adrenal localization is extremely rare. Only few cases have been reported in the literature. Classical management includes radical surgery with adjuvant chemotherapy or radiotherapy or both. This case report is the only one where recurrence was surgically removed, and it confirms the importance of adjuvant treatment, and the efficacy of neoadjuvant chemotherapy. Case presentation We report the case of a 23-year-old Moroccan woman presenting with flank pain. An abdominal computed tomography scan showed a large and enhancing left suprarenal mass. After radical nephrectomy, histologic examination revealed a small round cell proliferation. The diagnosis of Ewing sarcoma was confirmed by molecular analysis; time to final diagnosis was 5 months due to financial and coordination issues. Computed tomography (on an asymptomatic patient) revealed a locoregional recurrence, our patient received 12 cycles of the vincristine, doxorubicin and cyclophosphamide/ifosfamide and etoposide protocol used in an alternating schedule, with partial radiologic response (62%) and pathologic complete response, then underwent adjuvant radiotherapy of 45 Gy. The young women is still in remission after 36 months of follow-up. Conclusions Our patient had an early recurrence due to absence of adjuvant treatment, but did respond well to neoadjuvant chemotherapy with a pathologic complete response. Management of adrenal Ewing sarcoma could be extrapolated from skeletal one with good outcomes even in locoregional recurrence.
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Affiliation(s)
- Hanane Eddaoualline
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco.
| | - Khadija Mazouz
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Bouchra Rafiq
- Endocrinology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | | | - Nawal El Ansari
- Endocrinology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Rhizlane Belbaraka
- Medical Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Abdelhamid El Omrani
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Mouna Khouchani
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
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10
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Adrenal mass of unusual etiology: Ewing sarcoma in a young man. Radiol Case Rep 2018; 12:838-844. [PMID: 29484083 PMCID: PMC5823311 DOI: 10.1016/j.radcr.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
Ewing sarcoma and peripheral primitive neuroectodermal tumor belong to the Ewing sarcoma (ES) family of tumors originating from a primitive neural tube. We report a 31-year-old man who was admitted to the urology clinic with complaints of fever, nausea, and dysuria. A right-sided adrenal mass was detected during ultrasonography. The lesion was then evaluated with magnetic resonance imaging, which showed areas of necrosis amid heterogeneous solid areas. Whole body scan with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography and bone scan studies showed pulmonary and osseous metastatic foci. The mass and right kidney were removed by an open approach. An immunohistochemical and molecular workup enabled the diagnosis of ES. The patient also underwent radiotherapy and chemotherapy. The patient remained in fairly good health during the 18-month follow-up period, but showed progression of all metastatic foci and died 26 months after treatment. In conclusion, adrenal ES should be included in the differential diagnosis of nonfunctional adrenal lesions despite its rare occurrence.
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11
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Gao J, Chow E, Aloma A, Gupta P. Peripheral primitive neuroendocrine tumor of the chest wall-A case report with pathological correlation. Radiol Case Rep 2018; 13:392-396. [PMID: 29904480 PMCID: PMC6000041 DOI: 10.1016/j.radcr.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/04/2018] [Indexed: 12/20/2022] Open
Abstract
Primitive neuroectodermal tumor is a high-grade malignant tumor originating from the neural crest and neuroectoderm, which can be subdivided into central and peripheral categories. Peripheral primitive neuroectodermal tumor is thought to be identical to Ewing's sarcoma, and falls under a broader category of Ewing's sarcoma family of tumors. Very rarely, it may present without osseous involvement, known as extraosseous Ewing's sarcoma. Here we present a case of a 38-year-old woman, who presented with several-month history of a slow-growing chest wall mass, initially thought to be a breast mass. The mass was diagnosed as extraosseous Ewing's sarcoma upon tissue biopsy. The patient was started on a dose-intensified neoadjuvant therapy, based on protocol from pediatric population given rarity of this tumor in the adult population. While the patient was initially planned for surgical resection, the tumor showed excellent response to chemotherapy on follow-up imaging, and radiation therapy was elected in lieu of resection.
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Affiliation(s)
- Jidi Gao
- Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
- Corresponding author.
| | - Erika Chow
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Aishatu Aloma
- Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Payal Gupta
- Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
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12
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Guo H, Chen S, Liu S, Wang K, Liu E, Li F, Hou Y. Rare adrenal gland incidentaloma: an unusual Ewing's sarcoma family of tumor presentation and literature review. BMC Urol 2017; 17:24. [PMID: 28376845 PMCID: PMC5379633 DOI: 10.1186/s12894-017-0217-3] [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: 11/22/2016] [Accepted: 03/27/2017] [Indexed: 01/10/2023] Open
Abstract
Background Members of the Ewing’s sarcoma family of tumor (ESFT) are malignant neoplasms and rarely observed in the adrenal gland. Case presentation We report an extremely exceptional case of ESFT rising from the adrenal gland in a 57-year-old Chinese man. The patient was hospitalized with abdominal swelling for 2 months. Computed tomography (CT) scan revealed a nearly-circular mass measuring about 8.1 × 10.6 cm in the right adrenal region. The patient underwent right adrenal resection. Histopathologic examination found the tumor was composed of small round blue cells forming typical Homer-Wright rosettes in focal area. The immunohistochemical analysis confirmed the case to be ESFT, which was positive for membranous CD99 and nuclear FLI-1. The patient was scheduled for four courses of large doses of chemotherapy and died for cancer metastasis one year later after surgery. Conclusions Histopathological evidence of Homer-Wright rosettes and immunohistochemical markers positivity, such as CD99 and FLI-1, are valuable factors for ESFT diagnosis, although cytogenetic analysis is considered as the gold standard. Complete surgery is the treatment of choice for ESFT and adjuvant radiotherapy and combination chemotherapy can significantly improve the survival rate of postoperative patients.
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Affiliation(s)
- Hui Guo
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Shuaiqi Chen
- Department of Urology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, 453100, China
| | - Shukun Liu
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Kaixuan Wang
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Erpeng Liu
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Faping Li
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yuchuan Hou
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China.
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13
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Zhang L, Yao M, Hisaoka M, Sasano H, Gao H. Primary Ewing sarcoma/primitive neuroectodermal tumor in the adrenal gland. APMIS 2016; 124:624-629. [PMID: 27197626 DOI: 10.1111/apm.12544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/26/2016] [Indexed: 01/10/2023]
Abstract
Primary Ewing sarcoma or primitive neuroectodermal tumor (PNET) of the adrenal gland is extremely rare. We report a case of Ewing sarcoma or PNET of the adrenal in a 48-year-old Chinese woman. The patient was hospitalized with left upper quadrant abdominal pain and swelling that had been present for 1 year. Computed tomography (CT) images revealed a circumscribed mass in the left adrenal region measuring 12 cm in its greatest dimension, and the mass was surgically resected. Macroscopically, the mass (13 × 10 × 8 cm3 ) in the left adrenal gland was encapsulated, soft, appearing grayish white and yellow, and with foci of cystic degeneration, necrosis, and hemorrhage on cross-sectional. Non-tumorous adrenal tissue was compressed, but identifiable at the periphery of the specimen. Histologically, compact short spindle and oval tumor cells were arranged in sheets. Tumor cells tested positive for vimentin, CD99, Bcl-2, NKX2.2, EMA, and CD117, and weakly positive for FLI-1 on immunohistochemical analysis and showed rearrangement of the EWSR1 on fluorescence in situ hybridization analysis. Post-adrenalectomy, after being recurrence free for 4.5 years, the patient relapsed and a localized recurrence was detected on a follow-up CT scan.
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Affiliation(s)
- Lian Zhang
- Department of Pathology, The Second Hospital of Jilin University, Changchun, China
| | - Min Yao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, China
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational Environmental Health, Kitakyushu, Japan
| | - Hironobu Sasano
- Department of Anatomic Pathology Laboratory, Tohoku University School of Medicine, Sendai, Japan
| | - Hongwen Gao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, China
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Ewing sarcoma/peripheral primitive neuroectodermal tumor in the adrenal gland of an adolescent: a case report and review of the literature. J Pediatr Hematol Oncol 2014; 36:e456-9. [PMID: 24276043 DOI: 10.1097/mph.0000000000000058] [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] [Indexed: 11/26/2022]
Abstract
Ewing sarcoma/peripheral primitive neuroectodermal tumors (ES/pPNETs) typically occur in the long or flat bones, the chest wall, extraskeletal soft tissue, or less frequently, in solid organs. They can arise from anywhere in the body; however, ES/pPNETs arising from the adrenal gland are very rare, especially in children and adolescents. Herein, the authors report a case of an ES/pPNET in the adrenal gland of a 17-year-old girl, who was successfully treated with a multimodal treatment, with a brief review of the pertinent literature.
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