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Urdang ZD, Geltzeiler MN, Hargunani CA. Sinonasal Ewing's sarcoma: Recognition and management of a rare disease. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
The extra-skeletal form is an unusual type of Ewing sarcoma (ES) arising from soft tissue and in the literature there are reports of less than 50 patients describing the tumor in the paranasal sinuses and skull base. The histological diagnosis is crucial to plan the correct treatment and the molecular confirmation is mandatory in equivocal patients. A multimodality treatment with chemotherapy, surgery and radiotherapy improved the outcomes of these diseases during the last decades and a free-margin resection with the endoscopic transnasal technique is one of the most recent ways to manage these pathologies in selected patients, reducing the morbidities of the external approaches and preserving the quality of life of the patient.Here, the authors present the first patient of primary sinonasal ES free from disease after 5 years of follow-up and treated with an endoscopic endonasal approach and a second patient of sinonasal metastases of ES treated with and endoscopic transnasal approach.
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Suzuki T, Yasumatsu R, Nakashima T, Arita S, Yamamoto H, Nakagawa T. Primary Ewing's Sarcoma of the Sinonasal Tract: A Case Report. Case Rep Oncol 2017; 10:91-97. [PMID: 28203170 PMCID: PMC5301122 DOI: 10.1159/000455040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
A 23-year-old male presented with a 3-month history of left purulent rhinorrhea, progressive nasal obstruction, and intermittent epistaxis. A fiberoptic examination revealed a large vascular polypoid mass completely filling the left nasal cavity. CT and MRI scans showed a large hypervascular mass involving the left nasal airway, maxillary antrum, and the anterior ethmoid cells. There was no bony erosion or contiguous spread, and the remaining sinuses, orbit, and cranial fossa were uninvolved. The patient underwent complete removal of the mass via an external lateral rhinotomy approach. The soft mass was large and vascular. A microscopic analysis revealed an undifferentiated tumor consisting of a solid sheet of small, round blue cells. Mitotic figures were also present. Immunohistochemically, the tumor cells were strongly positive for CD99. Molecular studies using a PCR confirmed the chromosomal translocation of FLI1 (exon 6). These findings were considered diagnostic for Ewing's sarcoma. Postoperatively, the patient was treated with combined chemotherapy and radiotherapy. Adjuvant chemotherapy consisting of vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide (total: 7 cycles) was commenced. He also received radiation therapy for local control (total dose: 50.4 Gy). The patient is currently alive without any evidence of recurrence or metastasis.
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Affiliation(s)
- Tomoharu Suzuki
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryuji Yasumatsu
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Torahiko Nakashima
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Arita
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Thorn D, Mamot C, Krasniqi F, Metternich F, Prestin S. Multimodality Treatment in Ewing's Sarcoma Family Tumors of the Maxilla and Maxillary Sinus: Review of the Literature. Sarcoma 2016; 2016:3872768. [PMID: 27413360 PMCID: PMC4927945 DOI: 10.1155/2016/3872768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/07/2016] [Accepted: 04/27/2016] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- David Thorn
- Division of Medical Oncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Christoph Mamot
- Division of Medical Oncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Fatime Krasniqi
- Division of Medical Oncology, University Hospital Basel, 4031 Basel, Switzerland
| | - Frank Metternich
- Division of Ear, Nose and Throat, Head & Neck Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Sven Prestin
- Division of Ear, Nose and Throat, Head & Neck Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
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Sendul SY, Ucgul C, Kabukcuoglu F, Dirim B, Guven D. Primary orbital Ewing's sarcoma presenting with local recurrence to maxillary sinus shortly after tumor resection. J Surg Case Rep 2015; 2015:rjv070. [PMID: 26136562 PMCID: PMC4486869 DOI: 10.1093/jscr/rjv070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ewing's sarcoma (ES) is a malignant, small-round-cell neoplasm that normally affects the long bones of the limbs or the pelvis. Primary orbital ES of the skull has been considered extremely rare. We describe the case of a 19-year-old female patient with primary ES originating from the inferior orbital rime and, shortly after tumor resection, local recurrence to the maxillary sinus.
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Affiliation(s)
- Selam Yekta Sendul
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cemile Ucgul
- Ulucanlar Goz Training and Research Hospital, Altındag, Ankara, Turkey
| | - Fevziye Kabukcuoglu
- Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Burcu Dirim
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Dilek Guven
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Cruz S, Azevedo P, Trigueiros N, Rodrigues e Rodrigues M. Ewing's Sarcoma: A Rarity in Sinonasal Region. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cruz S, Azevedo P, Trigueiros N, Rodrigues e Rodrigues M. Ewing's sarcoma: A rarity in sinonasal region. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 66:171-4. [PMID: 24725583 DOI: 10.1016/j.otorri.2013.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/16/2013] [Accepted: 09/10/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Sara Cruz
- Head of the Otolaryngology Department, Hospital Pedro Hispano, Matosinhos, Portugal.
| | - Paula Azevedo
- Head of the Otolaryngology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Nuno Trigueiros
- Head of the Otolaryngology Department, Hospital Pedro Hispano, Matosinhos, Portugal
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Li M, Hoschar AP, Budd GT, Chao ST, Scharpf J. Primary Ewing's sarcoma of the ethmoid sinus with intracranial and orbital extension: case report and literature review. Am J Otolaryngol 2013; 34:563-8. [PMID: 23706594 DOI: 10.1016/j.amjoto.2013.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
The Ewing's sarcoma family of tumors is a group of cancers that commonly arises in young adults during their second decade of life. It frequently involves the trunk and long bones of the body with primary Ewing's sarcoma of the paranasal sinuses being exceedingly rare. We describe the case of a 39 year-old female with primary Ewing's Sarcoma originating from the ethmoid sinus with intracranial extension into the anterior cranial fossa and the orbit. The radiologic and histopathologic profiles are presented with a review of the literature. To our knowledge, this is the second reported case with the tumor involving the anterior cranial fossa, but the only case where immunochemical staining and molecular genetic analysis are available for definitive diagnosis.
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Gray ST, Chen YL, Lin DT. Efficacy of Proton Beam Therapy in the Treatment of Ewing's Sarcoma of the Paranasal Sinuses and Anterior Skull Base. Skull Base 2011; 19:409-16. [PMID: 20436842 DOI: 10.1055/s-0029-1220207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ewing's sarcoma involving the sinonasal cavity and anterior skull base is very rare. The purpose of this article is to present our experience with two such cases, which were both treated with combined chemotherapy and proton beam radiation therapy. The patients were selected from a retrospective medical record analysis that was conducted of all patients who were diagnosed with Ewing's sarcoma of the sinonasal cavity at the Massachusetts Eye & Ear Infirmary/Massachusetts General Hospital Cranial Base Center from 2004 to 2008. One of the patients underwent pretreatment endoscopic subtotal resection to facilitate proton beam radiation therapy. Response to treatment was assessed, post-treatment endoscopic biopsies were performed to assure eradication of disease, and treatment complications were recorded. Both patients completed chemotherapy and proton beam radiation therapy without complication. One patient completed treatment in December 2006 and remains disease free. The second patient completed treatment in March 2007 and remains disease free. Both patients developed headaches accompanied by frontal sinus opacification after treatment that required endoscopic drainage. After endoscopic drainage, the opacification and symptoms resolved.
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Affiliation(s)
- Stacey Tutt Gray
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Solitary extra-skeletal sinonasal metastasis from a primary skeletal Ewing's sarcoma. The Journal of Laryngology & Otology 2011; 125:861-4. [PMID: 21729453 DOI: 10.1017/s0022215111000764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Ewing's sarcoma is a rare, malignant tumour predominantly affecting young adolescent males. We describe a unique case of an isolated extra-skeletal metastasis from a skeletal Ewing's sarcoma primary, arising in the right sinonasal cavity of a young man who presented with severe epistaxis and periorbital cellulitis. RESULTS Histologically, the lesion comprised closely packed, slightly diffuse, atypical cells with round, hyperchromatic nuclei, scant cytoplasm and occasional mitotic figures, arranged in a sheet-like pattern. Immunohistochemical analysis showed positive staining only for cluster of differentiation 99 glycoprotein. Fluorescent in situ hybridisation identified the Ewing's sarcoma gene, confirming the diagnosis. MANAGEMENT Complete surgical resection was achieved via a minimally invasive endoscopic transnasal approach; post-operative radiotherapy. Ten months post-operatively, there were no endoscopic or radiological signs of disease. CONCLUSION Metastatic Ewing's sarcoma within the head and neck is incredibly rare and can pose significant diagnostic and therapeutic challenges. An awareness of different clinical presentations and distinct histopathological features is important to enable early diagnosis. This case illustrates one potential management strategy, and reinforces the evolving role of endoscopic transnasal approaches in managing sinonasal cavity and anterior skull base tumours.
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Hafezi S, Seethala RR, Stelow EB, Mills SE, Leong IT, MacDuff E, Hunt JL, Perez-Ordoñez B, Weinreb I. Ewing's family of tumors of the sinonasal tract and maxillary bone. Head Neck Pathol 2010; 5:8-16. [PMID: 21107767 PMCID: PMC3037459 DOI: 10.1007/s12105-010-0227-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
The Ewing's family of tumors (EFT) are malignant neoplasms affecting children and young adults. Most cases arise in the long bones or the pelvis. Primary EFT of head and neck is uncommon and primary sinonasal EFT is even rarer. Previous studies have not focused on the sinonasal region specifically, and the published literature on sinonasal EFT consists of sporadic case reports. Fourteen cases of sinonasal EFT were available and had H&Es for review and immunohistochemical stains for CD99, S100, keratins, synaptophysin and desmin. FISH or RT-PCR was performed for EWSR1 abnormalities on 8 cases. The 14 identified patients included 5 males and 9 females, ranging from 7-70 years of age (mean 32.4 years). Tumors involved nasal cavity (5), sinuses (5) or both (4). Five patients had dural, orbital or brain involvement. The majority involved bone radiologically and/or microscopically. All cases were composed of small cells with variable cytoplasmic clearing. Focal or prominent nesting was noted in most cases. All cases were positive for CD99. Keratins (AE1/3 and/or CAM5.2), S100 and synaptophysin were positive in 4, 3 and 5 cases, respectively. All cases were negative for desmin. The 8 cases tested by FISH or RT-PCR were positive for EWSR1 abnormalities. Follow-up in 8 patients ranged from 1-168 months (average 11.3 m) showing 1 death due to metastatic disease, 1 death due to local disease, 1 patient alive with metastases and 5 patients disease-free at last follow-up. Interestingly, however, an analysis of the literature suggests a better prognosis for sinonasal EFT than EFT overall.
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Affiliation(s)
- Sara Hafezi
- Department of Pathology, University Health Network, Toronto, ON Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Raja R. Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Edward B. Stelow
- Department of Pathology, University of Virginia, Charlottesville, VA USA
| | - Stacey E. Mills
- Department of Pathology, University of Virginia, Charlottesville, VA USA
| | - Iona T. Leong
- Departments of Pathology and Dentistry, Mount Sinai Hospital, Toronto, ON Canada
| | | | - Jennifer L. Hunt
- Department of Pathology, Massachusetts General Hospital, Boston, MA USA
| | - Bayardo Perez-Ordoñez
- Department of Pathology, University Health Network, Toronto, ON Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, ON Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
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Primary extraskeletal Ewing's sarcoma of the maxilla with intraorbital extension. Indian J Otolaryngol Head Neck Surg 2007; 59:273-6. [PMID: 23120451 DOI: 10.1007/s12070-007-0079-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Extraskeletal Ewing's sarcoma is often described as a tumour involving the soft tissues of the lower extremities and the paravertebral region. Primary Ewing's sarcoma of the cranium is extremely rare, with only 17 cases reported so far [24]. Involvement of the paranasal sinus is a very rare entity. Involvement of facial bones is characterized by clinical and radiological features distinct from those commonly observed in other sites. Because of the above peculiarities a delay in diagnosis and thus in starting treatment is very probable in such cases. Primary Ewings sarcoma rarely arises in the facial skeleton and only occasionally in the maxilla. To date, there have been 22 cases of maxillary Ewing's sarcoma reported in the English-language literature [25]. We report here a new case of Ewing's sarcoma localized to the maxillary sinus, nose and the orbit, successfully treated by surgery, local high dosage radiotherapy and systemic chemotherapy.
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Iriz A, Albayrak L, Eryilmaz A. Extraskeletal primary Ewing's sarcoma of the nasal cavity. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.pedex.2007.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harman M, Kiroğlu F, Kösem M, Unal O. Primary Ewing's sarcoma of the paranasal sinus with intracranial extension: imaging features. Dentomaxillofac Radiol 2004; 32:343-6. [PMID: 14709612 DOI: 10.1259/dmfr/17098962] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Extraskeletal Ewing's sarcoma is often described as a tumour involving the soft tissues of the lower extremities and the paravertebral region. Involvement of the paranasal sinus is a very rare entity. We present a case of primary Ewing's sarcoma of the paranasal sinus extending into the middle cranial fossa in a 40-year-old female. CT and MRI findings of this unusual case are discussed. To our knowledge, this case is the first to be reported with CT and MRI documentation.
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Affiliation(s)
- M Harman
- Department of Radiology, University of Yuzuncu Yil Faculty of Medicine, Van, Turkey.
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