Primitive neuroectodermal tumor in sinonasal region

Ewing Sarcoma of the Sinonasal Tract: A Scoping Review

OBJECTIVE

Ewing sarcoma (ES) is a rare aggressive malignancy that can present in the sinonasal region. The objective of this study is to investigate the demographics, presentation, management, and outcomes of patients with sinonasal ES.

DATA SOURCES

PubMed, Web of Science, SCOPUS, CINAHL, and Cochrane Library.

REVIEW METHODS

A scoping review of cases of sinonasal ES was performed. Inclusion criteria consisted of case reports, series, or retrospective reviews.

RESULTS

785 total articles were retrieved. 72 articles met inclusion criteria and were included in the final review for a total of 93 cases. 48 (53%) patients were male. Mean age at diagnosis was 26.4 years old (range 1-89). Nasal obstruction (N = 55, 59%), epistaxis (N = 35, 38%), and impaired vision (N = 29, 29%) were the most common symptoms. On examination, 38 (41%) patients had a nasal cavity mass. Most tumors (N = 33, 35%) were located in the maxillary sinus. 44 (47%) were left sided and 4 (4%) were bilateral. The most utilized treatment modalities were surgical resection with adjuvant chemoradiotherapy (N = 27, 29%), chemoradiotherapy alone (N = 24, 26%), and surgical resection with adjuvant chemotherapy (N = 14, 15%). 56 patients had no evidence of disease (60%), 14 patients died with disease (15%), and 9 patients were alive with disease (10%) at the time of follow-up.

CONCLUSIONS

To our knowledge, we report the first scoping review of sinonasal ES. Patients generally present with non-specific sinonasal symptoms. Surgery with adjuvant chemoradiation is the most common treatment modality for these patients.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:1571-1580, 2025.

Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Background

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

Methods

Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.

Results

A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy.

Conclusions

Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival.

Electronic supplementary material

The online version of this article (10.1186/s12901-018-0052-5) contains supplementary material, which is available to authorized users.

Multimodality Treatment in Ewing's Sarcoma Family Tumors of the Maxilla and Maxillary Sinus: Review of the Literature

The Ewing sarcoma family of tumors (ESFT) encompasses a group of highly aggressive, morphologically similar, malignant neoplasms sharing a common spontaneous genetic translocation that affect mostly children and young adults. These predominantly characteristic, small round-cell tumors include Ewing's sarcoma of the bone and soft tissue, as well as primitive neuroectodermal tumors (PNETs) involving the bone, soft tissue, and thoracopulmonary region (Askin's tumor). Extraosseous ESFTs are extremely rare, especially in the head and neck region, where literature to date consists of sporadic case reports and very small series. We hereby present a review of the literature published on ESFTs reported in the maxilla and maxillary sinus region from 1968 to 2016.

A peripheral primitive neuroectodermal tumor in the larynx: A case report and literature review

Primitive neuroectodermal tumors (PNETs) are malignant tumors comprised of small round cells of neuroectodermal origin. Current evidence indicates that peripheral PNETs (pPNETs), which arise in the non-central nervous system, possess histological similarity to Ewing's sarcoma. Though the occurrence of pPNETs in the head and neck region is rare, these are aggressive malignant tumors, and long-term survival rates following diagnosis remain poor. The current report presents a case of pPNET and evaluates its significance with regard to previous studies. In the present case, a tumor was located in the larynx of the patient, and was diagnosed as pPNET. Immunohistochemical analysis indicated that tumor cells were positive for cluster of differentiation 99. The patient was treated with surgery, multiagent chemotherapy and radiotherapy. Five years subsequent to treatment, the patient had survived and demonstrated no evidence of disease recurrence. In existing literature concerning pPNET located outside the head and neck region, it is recommended that patients are treated with a combination of resection with a wide surgical margin, multiagent chemotherapy and radiotherapy. The present case report concluded that the combination of surgery, systematic chemotherapy and radiotherapy, offers an improved outcome for pPNET localized to the head and neck region, compared with any of these therapies alone.

Sinonasal rhabdomyosarcoma in children and young adults

Rhabdomyosarcoma is an aggressive malignant tumor often developing in the head and neck in children. In the sinonasal region, rhabdomyosarcoma constitutes a clinically important group because of the difficulty of surgical resection and its generally poor prognosis. We reviewed the archival pathology materials of 39 cases of rhabdomyosarcoma of the head and neck in children and young adults. The diagnosis was made through light microscopy, immunohistochemistry, electron microscopy, and/or reverse-transcriptase polymerase chain reaction (RT-PCR) molecular testing. We identified 14 tumors in the nose and paranasal sinuses. Patients' ages ranged from 9 to 40 years. Thirteen of the tumors were of the alveolar subtype. In 11 cases, the tumor cells were poorly differentiated, forming a solid alveolar pattern. In 2 cases, there was evidence of rhabdomyoblastic differentiation. Only one case was classified as embryonal rhabdomyosarcoma. A significant number of tumor cells in these cases had clear or vacuolated cytoplasm. Four alveolar rhabdomyosarcoma tumors were tested by RT-PCR; all showed PAX3/FKHR chromosomal translocation. We conclude that sinonasal rhabdomyosarcoma is predominantly of the alveolar subtype and frequently shows clear cells. A review of the literature shows that these tumors carry a poor prognosis, partly because of their parameningeal location and partly because of their "undifferentiated" alveolar histology.

Primitive neuroectodermal tumor of the head and neck: incidence, diagnosis, and management

Primitive neuroectodermal tumors are in the Ewing's sarcoma family of tumors and are composed of small round cells. Because of their rare occurrence, optimal therapy is challenging, particularly if they occur in the head and neck. Diagnosis is based on history, immunostaining with at least 2 neural markers, ultrastructural examination, and evidence of an abnormal t(11;22)(q24;q12) translocation as the hallmark for the Ewing's sarcoma family. The prognosis in general is poor because of overt metastasis at the time of diagnosis. Of 27 reported patients with primitive neuroectodermal tumors of the head and neck, 23 were less than 20 years of age. Most patients presented with a tumor in the nasal cavity, paranasal sinuses, or neck. Symptoms developed rapidly (3.6 months, on average), and a lethal outcome occurred in 9 patients. This highly malignant tumor requires an aggressive combination of radical resection, chemotherapy, and radiotherapy. A close follow-up with regular radiographic examination for at least 5 years is mandatory.

A sinonasal primary Ewing's sarcoma

Nasal fractures are a common complaint familiar to all otolaryngologists. Sinonasal primary Ewing's sarcomas are extremely rare. The case of a 9-year-old boy is presented whose nasal fracture and subsequent lateral nasal wall hematoma revealed an underlying Ewing's sarcoma. There are several unusual features in the history and clinical course of this patient. Following biopsies, immunohistochemistry proved essential in distinguishing a Ewing's sarcoma from other small cell tumours. It is important that a seemingly common condition can be the first presentation of a less common, more sinister pathology.