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Violon F, Burns R, Mihoubi F, Audard V, Biau D, Feydy A, Larousserie F. Intramedullary, periosteal, and extraskeletal Ewing sarcomas: retrospective study of a series of 126 cases in a reference center. Skeletal Radiol 2022; 51:1659-1670. [PMID: 35179621 DOI: 10.1007/s00256-021-03983-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the proportion of extraskeletal, periosteal, and intramedullary Ewing sarcomas among musculoskeletal Ewing sarcomas. MATERIAL AND METHOD Our single-center retrospective study included patients with musculoskeletal Ewing sarcoma diagnosed between 2005 and 2019 in our pathology center (cases from our adult bone tumor referral center and adult and pediatric cases referred for review). Recurrences, metastases, and visceral Ewing sarcomas were excluded. Intramedullary Ewing sarcomas were defined by involvement of the medullary cavity. Periosteal cases were defined by involvement of the subperiosteal area without extension to the medullary cavity. Extraskeletal cases were defined by the absence of involvement of the bone tissue and the subperiosteal area. RESULTS Our series included 126 patients with musculoskeletal Ewing sarcoma, including 118 skeletal Ewing sarcomas (93.7%) and 8 extraskeletal Ewing sarcomas (6.3%). Of the 118 skeletal Ewing sarcomas 112 were intramedullary (88.9%) and 6 were periosteal (4.8%). Extraskeletal Ewing sarcomas were more common in women and in patients older than 40 (p < 0.05). DISCUSSION The 6.3% proportion of extraskeletal Ewing sarcoma is lower than the median of 30% estimated from the literature. This difference could be explained by an overestimation of extraskeletal Ewing sarcomas of the chest wall (Askin tumors), an underestimation of periosteal cases confused with extraskeletal cases, and the presence of "Ewing-like" soft tissue sarcomas in previous series. Because of its prognostic and therapeutic impact, the distinction of morphologic subtypes requires the cooperation of experienced radiologists and pathologists.
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Affiliation(s)
- F Violon
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France.,Faculté de Médecine de Nancy, Université de Lorraine, Nancy, France
| | - R Burns
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - F Mihoubi
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France
| | - V Audard
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France
| | - D Biau
- Université de Paris, Paris, France.,Service de Chirurgie Orthopédique, Hôpital Cochin, AP-HP, Paris, France
| | - A Feydy
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - F Larousserie
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France. .,Université de Paris, Paris, France.
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Chirila M, Muresan M, Ciuleanu E, Cosgarea M. Extraosseous Ewing sarcoma and peripheral primitive neuroectodermal tumor of the thyroid gland: Case report and review. EAR, NOSE & THROAT JOURNAL 2014; 92:E3-6. [PMID: 23599116 DOI: 10.1177/014556131309200419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Ewing family of tumors and peripheral primitive neuroectodermal tumor (pPNET) represent different manifestations of the same entity. Immunohistochemical and cytogenetic studies suggest that these tumors have a common origin. Ewing sarcoma is more common in bone, while pPNET is more common in soft tissues. Extraosseous Ewing sarcoma (EoES) is rare. We present the case of a 48-year-old man who presented with acute obstructive respiratory failure secondary to a large thyroid swelling. The patient was initially diagnosed with giant B-cell non-Hodgkin lymphoma and treated with chemotherapy. However, subsequent immunohistochemical staining of biopsy specimens revealed that the patient actually had EoES/pPNET of the thyroid gland. We performed a nearly complete surgical resection of the tumor plus a total laryngectomy and resection of five tracheal rings. However, the patient died of a cerebral metastasis 1 month later after he had completed one cycle of postoperative chemotherapy.
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Affiliation(s)
- Magdalena Chirila
- ENT Department, University of Medicine and Pharmacy "Iuliu HaŢieganu," Cluj-Napoca, 400012, V. Babeş Str., No. 8, Cluj-Napoca, Romania.
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3
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Saeedinia S, Nouri M, Alimohammadi M, Moradi H, Amirjamshidi A. Primary spinal extradural Ewing's sarcoma (primitive neuroectodermal tumor): Report of a case and meta-analysis of the reported cases in the literature. Surg Neurol Int 2012; 3:55. [PMID: 22629492 PMCID: PMC3356992 DOI: 10.4103/2152-7806.96154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/22/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Primary spinal primitive neuroectodermal tumors (PNET) and/or spinal extraskeletal Ewing's sarcoma family tumors (ESET) are rare lesions appearing in the spinal extradural space. One hundred forty-one primary spinal PNETs, including 29 intramedullary lesions, have been reported in the literature. Encountering a case of primary epidural EES/peripheral PNET (pPNET) in sacral level, which is the fifth one occurring at this level in the literature, we have tried to conduct a meta-analysis of the reported cases. Case Description: A 44-year-old lady with epidural EES/pPNET is reported here. She was once operated for L5/S1 herniated disc, which did not ameliorate her symptoms. The clinical, imaging, surgical, and histopathologic characteristics of our case are presented and wide search of the literature is also done. All the reports were level 3 or less evidences and most of the series had missing parts. 106 cases of primary intraspinal (extradural/extramedullary-intradural) EES/pPNET and 29 cases of primary intramedullary PNET (CNS-PNET) have been reported in the literature. The most common clinical presentation in both entities was muscle weakness proportionate to the tumor location. Distant metastasis occurred in 38 of 99 (38%) cases of primary intraspinal EES/pPNET, while the rate of metastasis was 48% in patients with PNETs occurring in the intramedullary region (P > 0.05). One-year survival rate of the patients who underwent chemo-radiation after total or subtotal resection was better than those who did not receive chemotherapy or radiotherapy, or did not have total or subtotal resection. However, this difference was not repeated in 2-year survival rate in any of the tumor groups. Conclusion: It seems that total or subtotal removal of the tumor and adjuvant chemo- and radiation therapy can improve the outcome in these patients.
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Affiliation(s)
- Saeed Saeedinia
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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D'souza M, Sharma R, Jaimini A, Tripathi M, Singh D, Mondal A. Spinal epidural metastasis from Ewing's sarcoma on PET/CT: A case report. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2011.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Spinal epidural metastasis from Ewing's sarcoma on PET/CT: A case report. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remn.2011.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Masoura S, Kourtis A, Kalogiannidis I, Kotoula V, Anagnostou E, Angelidou S, Agorastos T. Primary primitive neuroectodermal tumor of the cervix confirmed with molecular analysis in a 23-year-old woman: A case report. Pathol Res Pract 2012; 208:245-9. [PMID: 22365564 DOI: 10.1016/j.prp.2012.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 12/03/2011] [Accepted: 01/11/2012] [Indexed: 11/19/2022]
Abstract
Primitive Neuroectodermal Tumor (PNET) of the genital tract is very rare, especially in the cervix. A case report of a young woman with a diagnosis of PNET originating from the uterine cervix is presented here. A 23-year-old woman presented with abnormal uterine bleeding and sharp lower abdominal pain of two months duration. CT and MRI of the abdomen and thorax revealed the presence of a large mass in the uterine cervix, enlarged pelvic lymph nodes and broncho-pulmonary infiltrations with regional nodes. Pathological examination of the tumor revealed a malignant neoplasm composed predominantly of small cells, immunohistochemically positive for CD99, vimentin and c-Kit. Molecular testing demonstrated the expression of EWS/FLI1 fusion transcripts corresponding to the t(11;22)(q24;q12) translocation, which confirmed the diagnosis of PNET of the uterine cervix. Despite surgical excision and administration of the first cycle of adjuvant chemotherapy, the patient died from multiple-organ failure and cardiac arrest. PNET arising from the genital tract, especially in the uterine cervix, is very rare and presents a diagnostic challenge. A timely confirmation with molecular analysis is essential for the diagnosis of such a tumor at an unusual site as in the present case.
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MESH Headings
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cervix Uteri/pathology
- Cervix Uteri/surgery
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 22
- Combined Modality Therapy
- DNA, Neoplasm/analysis
- Fatal Outcome
- Female
- Humans
- Neuroectodermal Tumors, Primitive/diagnosis
- Neuroectodermal Tumors, Primitive/genetics
- Neuroectodermal Tumors, Primitive/metabolism
- Neuroectodermal Tumors, Primitive/therapy
- Oncogene Proteins, Fusion/genetics
- Pathology, Molecular
- Proto-Oncogene Protein c-fli-1/genetics
- RNA-Binding Protein EWS/genetics
- Translocation, Genetic
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/genetics
- Uterine Cervical Neoplasms/metabolism
- Uterine Cervical Neoplasms/therapy
- Young Adult
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Affiliation(s)
- Sophia Masoura
- 4th Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Whitefield J. A 12-year-old girl with sudden onset of numbness and tingling feet. Osseous Ewing's sarcoma of T2. Pediatr Ann 2010; 39:271-3. [PMID: 20506978 DOI: 10.3928/00904481-20100422-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Julia Whitefield
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of New Mexico, Albuquerque, NM, USA.
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8
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Primary intradural Ewing's sarcoma of the cauda equina presenting with acute bleeding. Acta Neurochir (Wien) 2010; 152:563-4. [PMID: 19779671 DOI: 10.1007/s00701-009-0484-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
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Lakhdar F, Gana R, Laghmari M, Moufid F, Maaqili R, Bellakhdar F. [Infected cervical epidural Ewing's sarcoma (case report)]. J Neuroradiol 2007; 35:51-5. [PMID: 17572493 DOI: 10.1016/j.neurad.2007.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ewing's sarcoma is a relatively rare osseous malignant tumour. The age of onset is generally in the youth. Epidural localisation of the malignant osseous tumour Ewing's sarcoma is exceptional. Only 29 cases were reported in surgical literature including only one infected case. OBSERVATION We report a case of a 24 years old patient who displayed a complete flaccid tétraplégia with T1 sensitive level. Spinal cord MRI documented a cervical posterior epidural process with peripheric gadolinium enhancement. Patient was operated in emergency. A C6 and C7 laminectomy allowed complete tumour resection with its purulent intratumoural collection revealed during the operation. A total tumour removal was performed. The immediate postsurgical evolution was remarkable, with a quasi complete recovery in the upper limbs. DISCUSSION Firstly described by James Ewing in 1921, the spinal epidural locations of the Ewing's sarcoma are rare without specific clinical signs generally presenting as a radiculo-medullary compression. Our case is the second infected epidural Ewing sarcoma reported in the literature. However the cause remains unexplained. For this spinal epidural extraosseous tumour, X-ray radiography failed to show any osseous lesions. On MRI, the usually found aspect is a T1 and T2 isosignal with gadolinium enhancement. CONCLUSION Through our observation, we underlined the scarcity of this pathology in the cervical epidural localization and the association with infection. We also emphasized on the complete removal, in order to give the best functional and vital outcome.
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Affiliation(s)
- F Lakhdar
- Service de neurochirurgie, hôpital Ibn-Sina, Rabat, Morocco.
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12
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Ozturk E, Mutlu H, Sonmez G, Vardar Aker F, Cinar Basekim C, Kizilkaya E. Spinal epidural extraskeletal Ewing sarcoma. J Neuroradiol 2007; 34:63-7. [PMID: 17316801 DOI: 10.1016/j.neurad.2007.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A rare case of extraskeletal Ewing sarcoma, arising primarily in the spinal epidural space is reported. An 18-year-old male presented with a 2-month history of right shoulder pain progressing to complete paraplegia and urinary retention over the course of 2 days. Magnetic resonance imaging demonstrated an extradural mass extending from the C6 to T1 level. Histopathologic examination confirmed the diagnosis. The literature is reviewed and radiological differential diagnosis of this rare neoplasm is briefly discussed.
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Affiliation(s)
- E Ozturk
- Department of Radiology, GATA Haydarpasa Teaching Hospital, Egitim Hastanesi, Uskudar, Istanbul, Turkey.
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Yamamoto Y, Washimi O, Ishimura D, Yamada H, Kuroda M, Matsubara M, Yonekawa M, Uchibori M. Primary Extraskeletal Ewing Sarcoma of the Thoracic Spinal Epidural Space: A Case Report. Clin Med Oncol 2007. [DOI: 10.4137/cmo.s332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cases of extraskeletal Ewing sarcoma (EES) originating primarily within the spinal epidural space, are very rare and have a very poor prognosis. There is no standard therapy for this disease. We report the case of a 23-year-old man presenting with symptoms of back pain and numbness of both legs for 10 days. Imaging studies revealed a dorsal soft-tissue, extradural mass at the T8–9 vertebral level. The patient underwent a laminectomy and complete excision of the tumor. The EES diagnosis was confirmed by histologic analysis including immunohistochemistry and by presence of the EWS-ERG due to the t (21: 22) (q22: q12) chromosomal translocation by a reverse transcriptase-polymerase chain reaction (RT-PCR). This is the first report of spinal epidural EES with presence of the EWS-ERG fusion transcript. Post-operatively, the patient received aggressive adjuvant chemotherapy and radiotherapy. At 63 months after surgery, the patient is without clinical or radiological evidence of recurrent or metastatic disease. Early discovery of EES and a complete resection followed by the aggressive treatment with radiation and chemotherapy may improve disease-free and overall survival.
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Affiliation(s)
| | - Osuke Washimi
- Department of Orthopaedic Surgery, Fujita Health University, Japan
| | - Daisuke Ishimura
- Department of Orthopaedic Surgery, Fujita Health University, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, Japan
| | - Makoto Kuroda
- Department of Pathology, Fujita Health University, Japan
| | - Masatake Matsubara
- Department of Orthopaedic Surgery, Aichi Cancer Center Aichi Hospital, Japan
| | - Masahiro Yonekawa
- Department of Orthopaedic Surgery, Aichi Cancer Center Aichi Hospital, Japan
| | - Mitsutosi Uchibori
- Department of Orthopaedic Surgery, Aichi Cancer Center Aichi Hospital, Japan
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Cypel TKS, Meilik B, Zuker RM. Extraskeletal Ewing's sarcoma in a great toe of a young boy. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2007; 15:165-8. [PMID: 19554151 PMCID: PMC2687502 DOI: 10.1177/229255030701500306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extraskeletal Ewing's sarcoma (EES) is a rare, soft tissue, malignant neoplasm histologically similar to skeletal Ewing's sarcoma. It occurs mainly in adolescents and young adults, and affects extremities in 36% of cases and central locations (commonly paravertebral regions) in the remainder. The differential diagnosis includes other small, blue, round cell tumours. A clinical case of EES involving a great toe in a young boy is reported. EES diagnosis was confirmed by features of histological analysis and immunohistochemistry, and by the presence of the t(11;22) chromosomal translocation.
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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