1
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Yamashita S, Yokosawa M, Ono S, Sugawara T, Kimura N, Endo H. Concurrent delayed recurrence of peripheral primitive neuroectodermal tumors in orbital and sellar/suprasellar regions in an older adult. Eur J Ophthalmol 2024:11206721241277251. [PMID: 39228192 DOI: 10.1177/11206721241277251] [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: 09/05/2024]
Abstract
BACKGROUND Peripheral primitive neuroectodermal tumors (pPNETs) are rare and aggressive small round cell tumors, tending to occur in the thoracic and paravertebral soft tissues in children and young adults. This report describes an exceptionally rare case of concurrent delayed recurrence of pPNET in the orbital and sellar/suprasellar regions in an older adult, with a discussion supported by a literature review. CASE PRESENTATION We report an 82-year-old woman with a history of orbital pPNETs resection at age 62, followed by gamma knife radiosurgery for local recurrence at age 66. She presented left eye pain, left eye protrusion, decreased vision in the right eye, and right homonymous hemianopia. MRI revealed extensive lesions in the left orbital cavity and sellar/suprasellar region, contiguous through the optic canal. The recurrent tumor was treated through a two-stage resection via transcranial and transsphenoidal approaches, which resulted in symptom improvement and a pathologic diagnosis of pPNETs. CONCLUSION This case highlights a highly rare instance of late-onset orbital pPNETs recurrence in an elderly patient, with evidence suggesting tumor progression into the sellar/suprasellar regions through the optic canal.
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Affiliation(s)
- Shota Yamashita
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Michiko Yokosawa
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Sadahide Ono
- Department of Pathology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Takayuki Sugawara
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Naoto Kimura
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Liu D, Liu X, Li X, Liu Y, Yu J. Primary endobronchial multifocal Ewing's sarcoma: a rare case report. Front Oncol 2024; 14:1431950. [PMID: 39281384 PMCID: PMC11392889 DOI: 10.3389/fonc.2024.1431950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/25/2024] [Indexed: 09/18/2024] Open
Abstract
Extraskeletal Ewing's sarcoma (ES) has been reported to originate from various sites. Primary endobronchial ES is an extremely rare bronchial tumor, especially multifocal lesions. This report describes a rare presentation of primary bronchial ES in a 31-year-old female who was referred to the emergency department of our hospital due to suspicion of a foreign body in the bronchus. Computed tomography and bronchoscopy revealed multiple polypoid nodules in the middle bronchus of her right lung, thus excluding the initial diagnosis. Infection-related laboratory tests and serum tumor markers were normal. The bronchial sleeve resection was performed to remove the tumor completely and the patient's clinical symptoms obviously improved. Subsequent imaging, histopathological, immunohistochemical and genetic analyses made a conclusive diagnosis of primary endobronchial ES. To our knowledge, this is the eighth case of primary bronchial ES reported in medical literature.
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Affiliation(s)
- Dan Liu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoge Liu
- Department of Ultrasound, Ya'an People's Hospital, Ya'an, China
| | - Xin Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yisha Liu
- Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Junlun Yu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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3
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Xiang F, Liu H, Tan X, Ma W, Chen Y. 68Ga-DOTA-IBA PET/CT and 18F-FDG PET/CT in Ewing Sarcoma. Clin Nucl Med 2024:00003072-990000000-01241. [PMID: 39104035 DOI: 10.1097/rlu.0000000000005402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
ABSTRACT A 29-year-old man with Ewing sarcoma in the right ankle underwent 68Ga-DOTA-IBA PET/CT and 18F-FDG PET/CT, both of which showed high radiotracer activity for the primary tumor. Interestingly, bone metastases were detected early using 68Ga-DOTA-IBA PET/CT for the sixth thoracic vertebrae and with 18F-FDG PET/CT for the bilateral humerus. Higher uptake of 68Ga-DOTA-IBA was found in both primary and metastatic sites of Ewing sarcoma. 177Lu-DOTA-IBA may be one of the possible therapies for metastatic or recurrent Ewing sarcoma.
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Affiliation(s)
| | | | - Xiaoqi Tan
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenzhe Ma
- From the The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
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4
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Park H, Plut D, Winant AJ, Lee EY. Pediatric Musculoskeletal Disorders: Keeping it Straight to Accurate Diagnosis. Semin Roentgenol 2024; 59:348-360. [PMID: 38997186 DOI: 10.1053/j.ro.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/17/2024] [Accepted: 03/28/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Halley Park
- Department of Radiology, Nicklaus Children's Hospital, Miami, Florida, 3100 Southwest 62nd Ave, Miami, FL.
| | - Domen Plut
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia; University of Ljubljana Faculty of Medicine, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA
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Rangankar V, Dhande A, Khaladkar SM, Kirdat Patil PP, Bhuibhar G. Primary Ewing's Sarcoma of the Kidney Mimicking Renal Cell Carcinoma With Widespread Metastasis: A Case Report and a Brief Review of the Literature. Cureus 2024; 16:e64896. [PMID: 39156398 PMCID: PMC11330583 DOI: 10.7759/cureus.64896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Ewing's sarcoma family of tumors (ESFTs) are a group of small round cell tumors with common morphological and genetic features, including Ewing's sarcoma of bone, primary extra-skeletal Ewing tumors, extraosseous Ewing sarcoma (EES), and Askin tumors. EES presenting as a primary renal mass is an exceedingly uncommon aggressive tumor with limited reported cases in the literature and often mimics other renal malignancies on imaging. We present a case of a 31-year-old man presenting with left flank pain and abdominal fullness of short duration. Radiological imaging studies showed a large heterogenous mass from the left kidney, confirmed to be Ewing's sarcoma on post-operative histopathological examination (HPE) and immunohistochemistry (IHC) studies. Subsequent follow-up showed extensive metastatic disease. EES of the kidney has a nonspecific presentation and imaging appearance necessitating a multi-disciplinary approach comprising radiological imaging with a high index of suspicion, HPE, IHC, and molecular analysis for the correct diagnosis.
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Affiliation(s)
- Varsha Rangankar
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Aryaman Dhande
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Sanjay M Khaladkar
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Prajakta P Kirdat Patil
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Gayatri Bhuibhar
- Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Pune, IND
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6
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Amori LA, Marhana IA, Wahyu D. Extraskeletal Ewing's sarcoma presenting as a mediastinal mass with vena cava superior syndrome: A rare case report. Int J Surg Case Rep 2024; 119:109724. [PMID: 38735214 PMCID: PMC11101866 DOI: 10.1016/j.ijscr.2024.109724] [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: 02/23/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Extraskeletal Ewing's Sarcoma is a rare entity of sarcoma that develops rapidly within soft tissue in any anatomic region, and the symptoms depend on its location. CASE PRESENTATION The X-ray examination of a 28-year-old man with shortness of breath, cough, weight loss, and chest pain showed malignant round cell, in which confirmed by immunohistochemical examination. The examination indicated positive Vimentin findings in the cytoplasm and positive FLI-1 in the nuclei of the tumour cells. The diagnosis was consistent with extraskeletal Ewing's sarcoma. The patient submitted to a chest conference and received radiotherapy related to SVCS before debulking surgery. DISCUSSION The diagnostic challenges associated with Ewing's sarcoma may arise due to its diverse histological spectrum. Further examination is required in order to distinguish Ewing's sarcoma from other tumours, as its radiological specificity is limited. A multimodal approach for treatment and therapy is necessary to highlight the specific requirements of the patient's condition. CONCLUSION Imaging modalities including X-rays and thoracic CT scans, supported by histopathological examination and immunohistochemistry, are essential for accurately diagnosing Extraskeletal Ewing's sarcoma. A multimodal approach may be considered as the best treatment for the patient with mediastinal Ewing's sarcoma.
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Affiliation(s)
- Lakcandra Amar Amori
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - RSUD Dr. Soetomo, Surabaya, Indonesia
| | - Isnin Anang Marhana
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - RSUD Dr. Soetomo, Surabaya, Indonesia.
| | - Dwi Wahyu
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - RSUD Dr. Soetomo, Surabaya, Indonesia
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Lahiri R, Rawat SS, Srikant K, Rao S. Intrathoracic Ewing's sarcoma in an adult masquerading as lung abscess. BMJ Case Rep 2024; 17:e256631. [PMID: 38296504 PMCID: PMC10831453 DOI: 10.1136/bcr-2023-256631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Intrathoracic extraskeletal Ewing's sarcoma (EES) is a relatively uncommon malignant tumour. Here, we present a scenario involving an adult man in his 20s with a large intrathoracic EES that manifested as a lung abscess. Preoperative diagnostic tests were inconclusive; hence, the patient underwent an exploratory thoracotomy for the excision of the mass. Histopathology revealed a small round blue cell tumour, and immunohistochemistry, along with fluorescence in situ hybridisation, confirmed the diagnosis of Ewing's sarcoma. Adjuvant chemoradiotherapy was recommended, but the patient did not comply. A year later, he presented with a recurrence of the intrathoracic mass and subsequently received adjuvant chemotherapy. Currently, he is in remission.
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Affiliation(s)
- Raja Lahiri
- CVTS, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | - Shubham Singh Rawat
- CVTS, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | | | - Shalinee Rao
- Pathology and Lab Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
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8
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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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9
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Simões AM, Sequeira-Mendes J, Santos AI. Beyond the Bones: A Case Report of Extraosseous Ewing Sarcoma. Cureus 2023; 15:e47961. [PMID: 38034204 PMCID: PMC10685669 DOI: 10.7759/cureus.47961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Ewing sarcoma (ES) is primarily recognized as a primary bone tumor; however, its extraosseous variant is exceptionally rare and presents unique clinical challenges. In this article, we report the case of a 22-year-old male who initially presented with abdominal swelling. Diagnostic tests included abdominal imaging and a CT scan, revealing a solid liver mass. A thorough evaluation confirmed it to be an extraosseous ES, supported by liver biopsy and immunohistochemistry demonstrating positive expression for AE1/AE3 and CD-99, along with genetic analysis revealing a rearrangement of the EWSR1 gene (translocation 22q12). The patient's treatment involved a multimodal approach, including perioperative chemotherapy, surgery, and postoperative chemotherapy, following which the patient remained in complete remission after 24 months. This case emphasizes the importance of considering rare malignancies such as ES in differential diagnoses for young patients with liver masses. It also accentuates the pivotal role of family physicians in early detection and holistic patient care, underscoring the need for comprehensive investigations when encountering persistent symptoms.
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Affiliation(s)
- Ana Margarida Simões
- Family Medicine, Unidade de Saúde Familiar A Ribeirinha, Unidade Local de Saúde Guarda, Guarda, PRT
| | - Joana Sequeira-Mendes
- Family Medicine, Unidade de Saúde Familiar A Ribeirinha, Unidade Local de Saúde Guarda, Guarda, PRT
| | - Ana Isabel Santos
- Family Medicine, Unidade de Saúde Familiar A Ribeirinha, Unidade Local de Saúde Guarda, Guarda, PRT
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10
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Li X, Qi S, Zhu T, Jiang Y, Wang W. Primary mediastinum Ewing's sarcoma with pleural effusion: A case report and literature review. Open Life Sci 2023; 18:20220669. [PMID: 37554964 PMCID: PMC10404896 DOI: 10.1515/biol-2022-0669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
Ewing's sarcoma (ES) is an aggressive cancer in young adults. Primary ES occurring in the chest with pleural effusion is even rarer. We report the case of a 15-year-old girl who presented with intermittent chest pain occurring for more than 2 months and cough and wheezing for 10 days. Radiological imaging showed a large soft tissue mass with multiple small vessel shadows near the left mediastinum and bloody pleural effusion in the left thorax. ES was diagnosed by positive immunostaining for CD99, FLI-1, and NKX2 combined with fluorescence in situ hybridization detection of the EWSR1 gene arrangement. With chemotherapy, lung computed tomography revealed that the tumor had become much smaller, and the fluid was absorbed. We report a case of extraskeletal Ewing's sarcoma (EES) in the mediastinum with pleural effusion, which is unusual and challenging. EES is a highly malignant tumor with a poor prognosis. Early diagnosis and treatment can improve the survival rate of patients.
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Affiliation(s)
- Xuhong Li
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, China
| | - Shan Qi
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, China
| | - Taiwen Zhu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, China
| | - Ying Jiang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, China
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11
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Liu H, Deng Y, Liu N, Huang J, Zhang W. Primary Extraskeletal Ewing Sarcoma of the Duodenum Revealed by 18 F-FDG PET/CT. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00597. [PMID: 37290415 DOI: 10.1097/rlu.0000000000004740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT Extraskeletal Ewing sarcoma of the duodenum is a relatively uncommon entity tumor. We report a case of extraskeletal Ewing sarcoma in a 21-year-old woman. She complained of abdomen pain and melena. 18 F-FDG PET/CT showed an intense uptake by the duodenum mass along with multiple FDG-avid enlarged lymph nodes in the mesentery, which was pathologically proven as extraskeletal Ewing sarcoma.
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Affiliation(s)
- Hao Liu
- From the Departments of Nuclear Medicine, and
| | - Yan Deng
- Pediatrics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Nan Liu
- From the Departments of Nuclear Medicine, and
| | - Jing Huang
- From the Departments of Nuclear Medicine, and
| | - Wei Zhang
- From the Departments of Nuclear Medicine, and
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12
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Zare F, Shahbazi N, Faraji N, Goli R, Mostafaei B, Anari S. A cruel invasion of Ewing's sarcoma of the skull: A rare case report. Int J Surg Case Rep 2023; 108:108380. [PMID: 37406533 PMCID: PMC10382727 DOI: 10.1016/j.ijscr.2023.108380] [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: 04/30/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Ewing's sarcoma, a highly malignant bone tumor, typically affects the pelvis and long bones of the lower extremities in children and young adults; primary involvement of the skull is rare. Primary Ewing's sarcoma arising from the skull is very rare. In most cases, this disease is fatal, although the prognosis of Ewing sarcoma improves with radiation and chemotherapy after surgery. CASE PRESENTATION This case is about 25-year-old woman who was referred to Omid Hospital in Urmia because of frequent headaches, where a tumor mass was found according to the results of CT scan. Biopsy confirmed small round cell sarcoma as the diagnosis. Chemotherapy was ineffective and tumor growth was unstoppable, causing the patient to die after 3 months. CLINICAL DISCUSSION Ewing's sarcoma can affect various parts of the human body, including bone and soft tissue, but rarely the skull. Ewing's sarcoma typically grows extradural and often reaches a very large size before invading the skull or being detected clinically. CONCLUSION In most cases, Ewing's sarcoma is fatal, although the prognosis of this disease improves with radiation and chemotherapy after surgery.
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Affiliation(s)
- Farzaneh Zare
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Niloofar Shahbazi
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University Zarand, Kerman, Iran
| | - Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Behnam Mostafaei
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Sina Anari
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University Maragheh Branch, Tabriz, Iran.
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13
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Wu SY, Hsu CK, Yue CT, Tsai YC. Large retroperitoneal extraskeletal Ewing's sarcoma with renal pedicle invasion: a case report. BMC Urol 2023; 23:95. [PMID: 37194057 DOI: 10.1186/s12894-023-01272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Extraskeletal Ewing's sarcoma (EES) is a rare malignant tumor primarily found in children and young adults. Localized disease can present with nonspecific symptoms such as local mass, regional pain, and increased skin temperature. More severe cases may present with systemic symptoms such as malaise, weakness, fever, anemia, and weight loss. Among these lesions, retroperitoneal sarcomas are relatively uncommon and difficult to diagnose. Since they are usually asymptomatic until large enough to compress or invade the surrounding tissues, most are already advanced at first detection. Traditionally, the treatment of choice is complete surgical resection, sometimes combined with postoperative radiotherapy and chemotherapy. We report a case of EES with left renal artery invasion in the left retroperitoneal cavity successfully treated with transarterial embolization and surgery. CASE PRESENTATION A 57-year-old woman with a negative family history of cancer presented at our Urology Department with a large left retroperitoneal tumor found by magnetic resonance imaging during the health exam. Physical examination showed a soft abdomen and no palpable mass or tenderness. Imaging studies showed that the tumor covered the entire left renal pedicle, but the left kidney, left adrenal gland, and pancreas appeared tumor free. Since the tumor tightly covered the entire renal pedicle, tumor excision with radical nephrectomy was advised. The patient underwent transarterial embolization of the left renal artery with 10 mg of Gelfoam pieces daily before surgical excision. Tumor excision and left radical nephrectomy were uneventful the day after embolization. Post-operatively, the patient recovered well and was discharged on day 10. The final histopathological analysis showed a round blue cell tumor consistent with an Ewing sarcoma, and the surgical margins were tumor free. CONCLUSIONS Retroperitoneal malignancies are rare but usually severe conditions. Our case report showed that retroperitoneal EES with renal artery invasion could be treated safely with transarterial embolization and surgery.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan
- Department of Urology, School of medicine, Tzu Chi University, Hualien, Taiwan
| | - Chun-Kai Hsu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan
- Department of Urology, School of medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Tai Yue
- Department of Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan.
- Department of Urology, School of medicine, Tzu Chi University, Hualien, Taiwan.
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14
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Marak JR, Singh N, Pathak S, Awasthi NP. Extraskeletal Ewing sarcoma presenting as an axillary mass with pulmonary metastases. BMJ Case Rep 2023; 16:e255060. [PMID: 36990653 PMCID: PMC10069519 DOI: 10.1136/bcr-2023-255060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Extraskeletal Ewing sarcoma (EES) is a tumour of rare variant of the Ewing sarcoma family of tumours. This family of tumours can have different features; however, these tumours are categorised on the basis of genetic translocation, specific molecular and immunohistochemical features. EES is seen commonly affecting young adults with poor prognosis and high mortality rates. It can be detected in various locations making its diagnosis more difficult. It can present with varied imaging features, often non-specific. However, imaging plays a vital role in the primary tumour assessment, local staging, preoperative management and surveillance. Management involves surgery with chemotherapy. Long-term prognosis in cases of metastatic disease is very poor. In literature, only three cases of axillary EES have been reported so far. Here, we report the fourth case of large EES originating in the left axillary region in a woman in her 20s. The patient was given neoadjuvant chemotherapy; however, the size of the tumour increased, which was later surgically treated with complete excision of the tumour. Unfortunately, the tumour metastasised to the lung for which the patient was irradiated. Afterwards, the patient presented to the emergency room with respiratory distress for which she was on ventilator support; sadly, the patient died after 1 week.
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Affiliation(s)
- James R Marak
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Radiodiagnosis & Imaging, CSMMU, Lucknow, India
| | - Swasti Pathak
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namrata P Awasthi
- Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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15
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Mendpara V, Sayed Mushir Ali A, Tango T, Bhadana R, Kanisetti V, Tiwari U, Sahu S, Pancholi M. A Case of Extraskeletal Ewing Sarcoma Treated With Wide Local Excision With Latissimus Dorsi Flap and Systemic Therapy. Cureus 2023; 15:e36175. [PMID: 37065414 PMCID: PMC10103811 DOI: 10.7759/cureus.36175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare tumor of the soft tissue that looks the same as skeletal Ewing sarcoma (ES). A male in his 50s was diagnosed with extraskeletal Ewing sarcoma (EES) of the right shoulder, which had infiltrated the muscles around the shoulder joints. Although uncommon, all members of the ES family of tumors, including EES, were treated following the same general protocol for sarcoma tumors. Due to the significant tumor size in this patient and local invasion, wide local excision and a latissimus dorsi flap were required. This case highlighted the management of EES, including the surgical removal of the mass on the right shoulder, followed by chemotherapy, which led to a successful outcome.
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16
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Heller D, Wasilewski G, Mustafa J, Chaudhry H, Lowery E, Borys D, Allam E. Extraskeletal Ewing sarcoma of the sciatic nerve. Radiol Case Rep 2023; 18:1221-1226. [PMID: 36660563 PMCID: PMC9842801 DOI: 10.1016/j.radcr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare tumor diagnosed in children or young adults and is even more unusual in individuals over 30 years of age. Due to its rare occurrence and low index of suspicion, this tumor can pose diagnostic and therapeutic challenges. We present a case of a 60-year-old male with EES of the sciatic nerve, an unexpected entity given the patient's age, tumor type, and tumor location. This can mimic a nerve sheath tumor on imaging.
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17
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Kumar R, Warmke LM, Wong WL. Ewing sarcoma of Hoffa fat pad in the knee: a case report and review of the literature on primary intraarticular sarcomas and Hoffa fat pad masses. Skeletal Radiol 2022; 52:1415-1420. [PMID: 36484842 DOI: 10.1007/s00256-022-04239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Abstract
Primary intraarticular sarcomas are rare. We describe a unique case of intraarticular Ewing sarcoma arising in Hoffa fat pad of knee in a woman. The patient was treated successfully with chemotherapy and left knee arthroplasty; however, the tumor recurred after 3 years.We review the literature on primary intraarticular sarcomas and Hoffa fat pad masses in the knee.
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Affiliation(s)
- Rajendra Kumar
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Laura M Warmke
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA.,Indiana University, IU Health Pathology Laboratory, Indianapolis, IN, 46202, USA
| | - Wei-Li Wong
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
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18
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Nasri S, Aqamour R, Haddar L, Guerrouj I, Haddar K, Aichouni N, Kamaoui I, Skiker I. Extraskeletal Ewing sarcoma: A case report. Radiol Case Rep 2022; 17:4809-4813. [PMID: 36238207 PMCID: PMC9550844 DOI: 10.1016/j.radcr.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Extraskeletal Ewing sarcoma is a rare tumor mainly affecting young people, of poor prognosis with very high mortality rates especially in metastatic forms. It can affect different locations, without specific clinical signs, which delays the diagnosis. Imaging plays an important role for diagnosis, staging, preoperative assessment and surveillance. The diagnosis should be set early to a better management. We report a case of a 30-year-old man with a large extraskeletal Ewing sarcoma of the left thigh. The patient was initially treated with chemotherapy. Unfortunately, the tumor has increased in size making surgery impossible. The patient ultimately died of pulmonary metastases.
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