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Basu S, Penumadu P, Munuswamy H, Srinivas BH, Gnanasekaran S. Primary Ewings Sarcoma of the Inferior Vena Cava. Vasc Endovascular Surg 2023; 57:290-294. [PMID: 36468778 DOI: 10.1177/15385744221144362] [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: 12/12/2022]
Abstract
INTRODUCTION Sarcomas of vascular origin are rare. A case of Ewings sarcoma of Inferior Vena Cava [IVC] is reported here. REPORT A 36-year-old lady presented with a 6-month history of bilateral pitting lower limb swelling and 1-month history of vaginal bleeding. Contrast-enhanced computed tomography of the thorax and abdomen revealed a soft tissue lesion extending from the cavoatrial junction to the junction of the middle hepatic vein with IVC. She underwent IVC resection (suprahepatic) and left lateral hepatectomy with dacron graft reconstruction. The pathology was suggestive of Ewings sarcoma and she received adjuvant chemotherapy. CONCLUSION Preoperative tissue diagnosis can be considered in vascular tumors to sequence the various treatment modalities for improved outcomes.
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Affiliation(s)
- Shibaji Basu
- Department of Surgical Oncology, 29988Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Prasanth Penumadu
- Department of Surgical Oncology, 29988Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Hemachandren Munuswamy
- Department of Cardiothoracic and Vascular Surgery, 29988Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Bheemanathi Hanuman Srinivas
- Department of Pathology, 29988Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, 29988Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Muratori F, Foschi L, Roselli G, Frenos F, Tamburini A, Palomba A, Greto D, Loi M, Beltrami G, Capanna R, Mondanelli N, Campanacci DA. Ewing family tumors of the appendicular skeleton: a retrospective analysis of prognostic factors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1557-1565. [PMID: 34324030 DOI: 10.1007/s00590-021-03077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Authors retrospectively analyzed possible prognostic factors in a series of patients affected by Ewing sarcoma of extremities (eEWS) and treated over a 20-year period at a single institution. METHODS Between 1997 and 2017, 88 bone eEWS were treated at our institution. Staging, age, gender, tumoral volume, local treatment, surgical margins, post-ChT necrosis were investigated for prognostic correlation with overall survival (OS) and event-free survival (EFS). Median follow-up was 74 months (1-236). RESULTS Staging of disease correlated with OS (81% vs 59%, p = 0.01) and not with EFS (68% vs 57%, p = 0.28) in localized vs metastatic eEWS at presentation. Age ≥ 14 years (p = 0.002) and volume ≥ 100 cm3 (p = 0.04) were significant negative prognostic factors. No difference was found in local treatment: OS was 76% vs 63% (p = 0.33), while EFS was 68% vs 49% (p = 0.06) after surgery alone or surgery + radiotherapy, respectively. Regarding surgical margins, OS was 76% vs 38% (p = 0.14), and EFS was 65% vs 33% (p = 0.14) in adequate vs not adequate, respectively. OS was 86% and 68% in good and poor responders, respectively (p = 0.13). CONCLUSION In eEWS, metastatic disease at presentation, age > 14 years and tumoral volume > 100 cm3 are negative prognostic factors. Intensified adjuvant ChT can improve prognosis in poor responders and metastatic patients.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy.
| | - Lorenzo Foschi
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
| | - Giuliana Roselli
- Department of Radiology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
| | - Angela Tamburini
- Department of Paediatric Oncoematology, Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Daniela Greto
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Mauro Loi
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Nicola Mondanelli
- Orthopaedic Clinic, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
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Abboud A, Masrouha K, Saliba M, Haidar R, Saab R, Khoury N, Tawil A, Saghieh S. Extraskeletal Ewing sarcoma: Diagnosis, management and prognosis. Oncol Lett 2021; 21:354. [PMID: 33747211 DOI: 10.3892/ol.2021.12615] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 02/02/2021] [Indexed: 12/26/2022] Open
Abstract
Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, which accounts for 20-30% of all reported cases of ES. Being uncommon, all members of the ES family tumors are treated following the same general protocol of sarcoma tumors. The present review summarizes the diagnosis, management and prognosis of EES, focusing on the differences between the subtypes of ESS. The clinical features and imaging of EES are also discussed. Magnetic resonance imaging is the modality of choice for diagnostic imaging and local staging, while core-needle biopsy with pathological testing is used to obtain a definitive diagnosis. Although several oncology groups endorse that ES family of tumors should be treated with similar algorithm and protocols, some studies have demonstrated that surgery and radiotherapy may be used as a form of local control. However, further studies are required to conclude the optimum treatment option for EES.
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Affiliation(s)
- Abdallah Abboud
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Karim Masrouha
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, NYU Langone Health, New York, NY 10016, USA
| | - Maelle Saliba
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Rachid Haidar
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Nabil Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Ayman Tawil
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1013, Lebanon
| | - Said Saghieh
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1013, Lebanon
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4
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Boyce-Fappiano D, Guadagnolo BA, Ratan R, Wang WL, Wagner MJ, Patel S, Livingston JA, Lin PP, Diao K, Mitra D, Farooqi A, Lazar AJ, Roland CL, Bishop AJ. Evaluating the Soft Tissue Sarcoma Paradigm for the Local Management of Extraskeletal Ewing Sarcoma. Oncologist 2020; 26:250-260. [PMID: 33289298 DOI: 10.1002/onco.13616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We reviewed our experience treating patients with localized extraskeletal Ewing sarcoma (EES) to determine optimal local management strategies for this rare disease. METHODS Sixty patients with localized EES treated at our institution between 1994 and 2018 were reviewed. The Kaplan-Meier method was used to estimates disease outcomes. RESULTS The median follow-up time was 74 months (interquartile range [IQR], 17-121). Half the patients (n = 30) received combined-modality local therapy (CMT) with both surgery and radiation therapy (RT), whereas the other half received single-modality local therapy (SMT) with either surgery or RT. All patients received chemotherapy. The 5-year overall survival was 76%. Twenty-two patients (37%) developed recurrence at a median time of 15 months (IQR, 5-56 months) resulting in 3-year progression-free survival (PFS) of 65%. On univariate analysis, the use of both neoadjuvant and adjuvant chemotherapy was associated with improved 5-year PFS (71% vs. 50%, p = .04) compared with those who received one or the other. Furthermore, 11 patients (18%) developed local recurrences at a median time of 14 months (IQR, 2-19 months), resulting in a 5-year local control (LC) rate of 77%. Use of CMT was not associated with improved LC (83% vs. 72% SMT, p = .41). Also, use of CMT was the only factor associated with poorer disease-specific survival (vs. SMT; hazard ratio, 3.4; p = .047; 95% confidence interval, 1.01-11.4). CONCLUSION For patients with EES, CMT was not associated with a decreased rate of local relapse. These data suggest that SMT alone may be sufficient for LC in select patients. A multi-institutional collaborative effort should be considered to validate these findings. IMPLICATIONS FOR PRACTICE Extraskeletal Ewing sarcoma is a rare chemosensitive sarcoma whose clinical course more closely follows Ewing sarcoma of bone rather than that of other soft tissue sarcomas. Based on this study, combined-modality local therapy did not confer a local control advantage compared with single-modality local therapy. Therefore, single-modality local therapy is likely adequate in select patients with favorable disease features, which has the advantage of ensuring prompt administration of systemic therapy. A multi-institutional collaborative effort is warranted to determine which patients may benefit from de-escalated local therapy.
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Affiliation(s)
- David Boyce-Fappiano
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Ashleigh Guadagnolo
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ravin Ratan
- Departments of Sarcoma Medical Oncology, , The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei-Lien Wang
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Wagner
- Division of Medical Oncology, University of Washington, Seattle, Washington, USA
| | - Shreyaskumar Patel
- Departments of Sarcoma Medical Oncology, , The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John A Livingston
- Departments of Sarcoma Medical Oncology, , The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick P Lin
- Departments of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kevin Diao
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Devarati Mitra
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahsan Farooqi
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander J Lazar
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L Roland
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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5
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Muratori F, Mondanelli N, Pelagatti L, Frenos F, Matera D, Beltrami G, Innocenti M, Capanna R, Roselli G, Scoccianti G, Livi L, Greto D, Muntoni C, Baldi G, Tamburini A, Campanacci DA. Clinical features, prognostic factors and outcome in a series of 29 extra-skeletal Ewing Sarcoma. Adequate margins and surgery-radiotherapy association improve overall survival. J Orthop 2020; 21:236-239. [PMID: 32273664 DOI: 10.1016/j.jor.2020.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 01/04/2023] Open
Abstract
Objective Authors review a series of 29 extra-skeletal Ewing Sarcoma (EES). Methods They analyzed characteristics, prognostic factors and outcome of EES. Results Authors report 60% Overall Survival (OS) and 56% of Event Free Survival (EFS) at 5 years. Better 5 years EFS was found in patients with localized disease (68.8%) compared to metastatic EES (33.3%) (p = 0.042). Radiotherapy + surgery offered the best local treatment (p=0.017). Volume (p = 0.032), Surgical margins (p = 0.01), metastatic disease (p = 0.0013) were a significant prognostic factor for OS at 5-yrs. Conclusion Adequate margins and surgery+radiotherapy improve Overall Survival.
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Affiliation(s)
- Francesco Muratori
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Nicola Mondanelli
- Divisione Ortopedia e Traumatologia Azienda Ospedaliera Universitaria Siena, Italy
| | - Lorenzo Pelagatti
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Filippo Frenos
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Davide Matera
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Giovanni Beltrami
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Matteo Innocenti
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | | | - Giuliana Roselli
- Istituto di Radiologia Azienda Ospedaliera Universitaria Careggi Firenze, Italy
| | - Guido Scoccianti
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Lorenzo Livi
- Istituto di Radioterapia, Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Daniela Greto
- Istituto di Radioterapia, Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Cristina Muntoni
- Istituto di Radioterapia, Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Giacomo Baldi
- Divisione di Oncologia Medica, Ospedale Prato, Italy
| | | | - Domenico Andrea Campanacci
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
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Role of Radiation Therapy in Adult Extraskeletal Ewing's Sarcoma Patients Treated with Chemotherapy and Surgery. Sarcoma 2019; 2019:5413527. [PMID: 31178655 PMCID: PMC6507246 DOI: 10.1155/2019/5413527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/13/2019] [Indexed: 12/23/2022] Open
Abstract
Radiation therapy (RT) is advocated in the multimodal treatment of high-grade soft tissue sarcoma (STS), but its role may be less clear in chemotherapy-sensitive STS such as extraskeletal Ewing sarcoma (EES). The purpose of this study was to determine the role of RT on overall survival (OS) in localized EES adult patients treated with chemotherapy and surgery. Adult patients diagnosed with EES and reported to the National Cancer Database from 2004 to 2014 were evaluated. All patients were treated with surgical resection. Patient demographics, tumor characteristics, treatments received, resection margins, and survival were examined for the 232 patients identified. Using multivariate analysis and Cox proportional hazard analysis, predictors of OS were determined. In the overall cohort, 40 percent of patients received RT and 78 percent received chemotherapy, with 31 percent receiving both. The addition of RT to the patients receiving surgery + chemotherapy did not improve OS (p < 0.05). Twenty-four percent of patients who achieved R0 resection after surgery still received RT without any improvement in OS. Patients treated at community cancer centers were more likely to receive additional RT compared with Comprehensive Cancer Centers (p < 0.05). In adult EES patients with localized disease treated with chemotherapy and surgery, the addition of RT does not improve overall survival.
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Bang JS, Adsul N, Lim JH, Jang IT. Extra-Osseous Ewing Sarcoma of Sciatic Nerve Masquerading as Benign Nerve Sheath Tumor and Presented as Lumbar Radiculopathy: Case Report and Review of Literature. World Neurosurg 2018; 115:89-93. [PMID: 29673820 DOI: 10.1016/j.wneu.2018.04.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Extraosseous Ewing sarcoma (EES) arising from peripheral nerves is extremely rare with only 11 cases mentioned in the literature. It poses a diagnostic challenge to the clinicians due to its nonspecific presentation and rare occurrence. CASE DESCRIPTION A 56-year-old woman came with a history of low back pain and intractable right leg pain. Physical examination revealed the normal motor power of both lower limbs with decreased sensation along the lateral aspect of the foot with decreased ankle reflex. There was no improvement with conservative management. It was a diagnostic challenge due to its presentation like a lumbar radiculopathy, which was further endorsed by magnetic resonance imaging findings of foraminal stenosis. Due to red flags such as unrelenting pain at rest and history of thyroid tumor, we proceeded with magnetic resonance imaging of the hip, which was suggestive of right sciatic nerve sheath tumor. Excisional biopsy was confirmed as EES, and the patient was subsequently started on chemoradiotherapy. CONCLUSION A high index of suspicion is required for early diagnosis of EES. It can present as lumbar radiculopathy and mimic benign nerve sheath tumor on imaging. These sarcomas must be managed with a multidisciplinary approach.
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Affiliation(s)
- Jung Soo Bang
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea.
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
| | - Jae-Hyeon Lim
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Seoul, South Korea
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Caracterização, análise de sobrevida e expressão de IGFR nas amostras tumorais dos pacientes com diagnóstico dos tumores da família Ewing tratados no Hospital de Câncer de Barretos. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ferreira AJ, Boldrini E, López RVM, Scapulatempo Neto C, Santos JFC, Lopes LF. Characterization, survival analysis, and expression of IGFR in tumor samples from patients diagnosed with Ewing family tumors treated at the Barretos Cancer Hospital. Rev Bras Ortop 2016; 52:705-713. [PMID: 29234655 PMCID: PMC5720841 DOI: 10.1016/j.rboe.2016.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/04/2016] [Indexed: 01/24/2023] Open
Abstract
Objectives Study the clinical characteristics of patients diagnosed with Ewing family tumors (EFTs) and survival analysis based on risk criteria and expression of the surface protein known as insulin-like growth factor (IGFR). Methods This was a retrospective cohort study based on clinical data from 77 patients diagnosed with EFTs treated by the Department of Pediatric Oncology at the Barretos Cancer Hospital in a period between 2003 and 2012. Biological samples of patients were examined for the presence of the surface receptor IGFR. Results The overall survival rate (OSR) of patients included in the study was 45% at five years, and EFS was 30% at five years. Metastasis at diagnosis was present in 44.2% of the sample; 88.2% of the sample was male (p < 0.001). The evaluation of the expression of IGFR in biological samples of patients was associated with the variable metastasis at diagnosis (p < 0.001). Worse prognosis was observed in patients with extrapulmonary metastasis (p = 0.009). The local treatment of neoplasia presented better prognosis in patients undergoing local surgical treatment (p < 0.001). Conclusions These results showed a higher incidence of metastasis at diagnosis in patients with EFTs treated at the Barretos Cancer Hospital (BCH). Extrapulmonary metastases were a negative prognostic factor in this study. Surgical treatment of the primary tumor was a factor for better prognosis. Strong expression of IGFR was more frequent in patients with metastases at diagnosis, but did not represent a prognostic factor for EFTs.
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Affiliation(s)
| | - Erica Boldrini
- Hospital de Câncer Infanto-Juvenil de Barretos, Oncologia Pediátrica, Barretos, SP, Brazil
| | | | | | | | - Luiz Fernando Lopes
- Hospital de Câncer Infanto-Juvenil de Barretos, Oncologia Pediátrica, Barretos, SP, Brazil
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Abstract
STUDY DESIGN Case report. OBJECTIVE We present a case of isolated primary epidural lumbar Ewing sarcoma and review the current literature on the standard management. We also propose laminoplasty as safe procedure in this patient population that can provide good stabilization in young people. SUMMARY OF BACKGROUND DATA Primary epidural Ewing's sarcoma is a very rare entity. The best generally accepted treatment option in sarcomas is to achieve a gross total resection with safe margins followed by local radiotherapy and chemotherapy. A total resection with safe margins is a great challenge in neurosurgical patients. METHODS We present a previously healthy 17-year-old girl who complained of right sciatica with an epidural lumbar mass at L3-L4. She underwent complete resection of the tumor and a laminoplasty, which, in our experience, is a good way to preserve stability. RESULTS At surgery, an isolated and noninvasive lesion was identified. Histopathological confirmation of Ewing sarcoma was obtained by immunohistochemical study and EWSR1 gene rearrangement detection. Treatment with 6 months of chemotherapy resulted in no further identifiable lesions by PET and MRI imaging at 4 years postsurgery. The laminoplasty has remained stable. CONCLUSION Primary epidural Ewing sarcoma is extremely rare. The detection of the EWSR1 gene rearrangement can help to diagnose these tumors. The decision on how to treat these patients is difficult and can hardly be based on data from the current literature because of the small number of patients. The laminoplasty procedure can be safely performed in the setting of sarcoma of the epidural space.
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11
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Ijichi K, Tsuzuki T, Adachi M, Murakami S. A peripheral primitive neuroectodermal tumor in the larynx: A case report and literature review. Oncol Lett 2016; 11:1120-1124. [PMID: 26893703 DOI: 10.3892/ol.2015.4013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 08/26/2015] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Kei Ijichi
- Department of Otolaryngology - Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Toyonori Tsuzuki
- Department of Pathology, Nagoya Daini Red Cross Hospital, Nagoya, Aichi 466-8650, Japan
| | - Makoto Adachi
- Department of Oral and Maxillofacial Surgery, Asahi University Murakami Memorial Hospital, Gifu 500-8856, Japan
| | - Shingo Murakami
- Department of Otolaryngology - Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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Barbosa Neto O, Garant A, Shakir S, Brossard J, Garde-Granger P, Freeman C. Whole Abdominal-Pelvic Radiotherapy in the Management of Primary Ewing Sarcoma of the Peritoneal Cavity. Cureus 2016; 8:e455. [PMID: 26918223 PMCID: PMC4752370 DOI: 10.7759/cureus.455] [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] [Indexed: 11/11/2022] Open
Abstract
Ewing sarcoma of the abdomen is a rare entity in pediatric oncology and represents a technical challenge both for surgeons and radiation oncologists. We document the case of a young female patient with primary disseminated, intraperitoneal Ewing sarcoma who after an excellent response to chemotherapy received preoperative whole abdominal-pelvic radiotherapy with good tolerance.
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13
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Extraosseous Ewing Sarcoma: Diagnosis, Prognosis and Optimal Management. Indian J Surg 2015; 78:49-53. [PMID: 27186040 DOI: 10.1007/s12262-015-1399-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
Extraosseous Ewing sarcomas (EESs) are rare tumours originating from soft tissues. Their clinical picture depends mainly on the primary site of the sarcoma. Patient characteristics and outcomes seem to be different in EES compared to patients with skeletal Ewing sarcoma, with implications for patient care and prognosis. However, multimodality therapeutic strategies are recommended for all types of the Ewing tumour family. The available diagnostic tools include ultrasonographic evaluation and computed tomography (CT) or magnetic resonance imaging as well as histopathologic and immunohistochemical tissue examination. Several histologic and genetic biomarkers have been established, although their utilization needs to be further tested by larger prospective studies. Regarding localized disease, the recommended treatment remains surgery. However, chemotherapy can be added to achieve improved survival, with neoadjuvant regimens showing more promising results than adjuvant regimens. Radiotherapy is an option to obtain local control, although its complications have reduced its utilization. In metastatic or recurrent disease, systematic chemotherapy improves survival.
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14
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Sharma A, Brown K, Skinner J, Whelan J, Fox M. Extraskeletal Ewing's Sarcoma Arising from the Sciatic Nerve: A Diagnostic Challenge. Case Rep Surg 2015; 2015:172635. [PMID: 26236533 PMCID: PMC4510112 DOI: 10.1155/2015/172635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 12/01/2022] Open
Abstract
Ewing's sarcoma is a common bone tumour of childhood but is a rare occurrence in individuals over 20 years of age. Few cases are reported as originating from peripheral nerves. We present an unusual case of extraosseous Ewing's sarcoma originating from the sciatic nerve in a 66-year-old patient which had the clinical hallmarks of a benign nerve sheath tumour. Following discussion at a multidisciplinary meeting, excision biopsy of the suspected benign nerve sheath tumour was planned. At operation, the mass had malignant features. Histology confirmed the presence of Ewing's sarcoma. Due to the morbidity of nerve resection, radiotherapy and chemotherapy were commenced. Ewing's sarcoma is known to mimic benign pathologies. In this case there were subtle signs of a malignant process in the form of unremitting pain. It is vital to keep in mind the less common tumours that can affect the peripheral nervous system in such cases.
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Affiliation(s)
- Aadhar Sharma
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
| | - Kate Brown
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
| | - John Skinner
- Sarcoma Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
| | - Jeremy Whelan
- Department of Clinical Oncology, University College Hospital, Euston Road, London NW1 2BU, UK
| | - Michael Fox
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
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Tao HT, Hu Y, Wang JL, Cheng Y, Zhang X, Wang H, Zhang SJ. Extraskeletal Ewing sarcomas in late adolescence and adults: a study of 37 patients. Asian Pac J Cancer Prev 2015; 14:2967-71. [PMID: 23803063 DOI: 10.7314/apjcp.2013.14.5.2967] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extraskeletal Ewing sarcoma (EES)/primitive neuroectodermal tumours (PNET) are rare soft tissue sarcomas. Prognostic factors and optimal therapy are still unconfirmed. MATERIALS AND METHODS We performed a retrospective analysis on patients to explore the clinic characteristics and prognostic factors of this rare disease. A total of 37 patients older than 15 years referred to our institute from Jan., 2002 to Jan., 2012 were reviewed. The characteristics, treatment and outcome were collected and analyzed. RESULTS The median age was 28 years (range 15-65); the median size of primary tumours was 8.2 cm (range 2-19). Sixteen patients (43%) had metastatic disease at the initial presentation. Wide surgical margins were achieved in 14 cases (38%). Anthracycline or platinum-based chemotherapy was performed on 29 patients (74%). Radiotherapy was delivered in 13 (35%). At a median follow-up visit of 24 months (range 2-81), the media event-free survival (EFS) and overall survival (OS) were 15.8 and 30.2 months, respectively. The 3-year EFS and OS rates were 24% and 43%, respectively. Metastases at presentation and wide surgical margins were significantly associated with OS and EFS. Tumour size was significantly associated with OS but not EFS. There were no significant differences between anthracycline and platinum based chemotherapy regarding EFS and OS. CONCLUSIONS EES/PNET is a malignant tumour with high recurrence and frequent distant metastasis. Multimodality therapy featuring wide surgical margins, aggressive chemotherapy and adjuvant local radiotherapy is necessary for this rare disease. Platinum-based chemotherapy can be used as an adjuvant therapy.
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Affiliation(s)
- Hai-Tao Tao
- Department of Oncology, China PLA General Hospital, Beijing, China
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16
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Biswas B, Shukla NK, Deo SVS, Agarwala S, Sharma DN, Vishnubhatla S, Bakhshi S. Evaluation of outcome and prognostic factors in extraosseous Ewing sarcoma. Pediatr Blood Cancer 2014; 61:1925-31. [PMID: 25132242 DOI: 10.1002/pbc.25095] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/21/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on extraosseous Ewing sarcoma (EES) with uniform chemotherapy protocol are minimal. We aimed to examine this aspect in our patients, identify prognostic factors and compare the same with osseous Ewing sarcoma. PROCEDURES A single institutional data review of patients with EES treated between June 2003 and November 2011 with uniform chemotherapy and evaluated on intent-to-treat analysis was done. RESULTS Of 374 patients with Ewing sarcoma, 60 (16%) were EES with median age 16 years; 20 (33%) had metastases. After median follow-up of 25 months (range: 1.7-104.4), 5-year event free survival (EFS), OS, and local-control-rate were 47.1 ± 7.9%, 61.6 ± 7.8%, and 77.9 ± 8.6%, respectively for entire EES cohort. In multivariate analysis, hemoglobin ≤ 10 g/dl (P = 0.03), and white blood cell count (WBC) >11 × 10(9) /L (P = 0.009) predicted inferior EFS for the entire EES cohort. Low hemoglobin (P = 0.05) and high LDH (P = 0.01) predicted inferior OS for the entire EES cohort on multivariate analysis. As compared to the cohort of skeletal primary (n = 314), higher proportion of patients underwent surgery in the cohort of EES (P = .003); EFS (P = 0.004) and OS (P = 0.08) were superior for patients with EES than patients with skeletal Ewing sarcoma. CONCLUSION These data of EES suggests that low hemoglobin and high WBC count adversely affect EFS. Overall outcome was significantly better for EES than skeletal primary tumors.
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Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Extraskeletal Ewing sarcoma in children and adolescents: impact of narrow but negative surgical margin. Pediatr Surg Int 2013; 29:1303-9. [PMID: 23982393 DOI: 10.1007/s00383-013-3409-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study was to determine the impact of negative but close resection margins on local recurrence in children with extraskeletal Ewing sarcoma (EES). METHOD We reviewed records of 32 patients with EES treated between March 2005 and March 2013. All patients except one underwent surgical excision either upfront or after induction chemotherapy. Patients with viable tumor and negative surgical margins, which were categorized as less than or greater than 1 cm, were selected. Local control and survival analysis were performed for patients in both the groups. RESULTS The 5-year event-free and overall survival rates of entire cohort is 68 and 77 %, respectively. Surgical margins were negative in 23/26 (90.3 %) patients. There were no local recurrences in any of the patients with margins of less than 1 cm. Only one patient with a margin greater than 1 cm had a local recurrence along with distant metastases. A tumor-free margin of more than 1 cm did not affect overall or event-free survival (p = NS). CONCLUSION Optimal local control is feasible in children with EES regardless of the quantitative extent of negative margins. Achieving a three-dimensional tumor-free margin should be the goal of surgical resection.
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Arpaci E, Yetisyigit T, Seker M, Uncu D, Uyeturk U, Oksuzoglu B, Demirci U, Coskun U, Kucukoner M, Isıkdogan A, Inanc M, Alkis N, Ozkan M. Prognostic factors and clinical outcome of patients with Ewing’s sarcoma family of tumors in adults: multicentric study of the Anatolian Society of Medical Oncology. Med Oncol 2013; 30:469. [DOI: 10.1007/s12032-013-0469-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/10/2013] [Indexed: 02/03/2023]
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19
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Ewing sarcoma of the thoracic epidural space in a young child. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 3:S373-9. [PMID: 22907727 DOI: 10.1007/s00586-012-2481-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 06/14/2012] [Accepted: 08/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To report on the clinical course and treatment of Ewing sarcoma of the thoracic epidural space in a 5-year-old girl. METHODS We present the case of a 5-year-old girl who experienced back pain (day 1); on day 10, the pain had exacerbated and involuntary movements in the lower limbs occurred, and an MRI performed in her local hospital revealed a tumor lesion at the upper thoracic level. RESULTS On day 13, emergency surgery was performed for partial resection of the tumor. Pathological examination of the resected tumor by immunostaining and gene testing revealed that it was MIC2 positive and an EWS-FLI 1 chimera, respectively, and Ewing sarcoma was diagnosed. The involuntary movements resolved immediately after the surgery. Three weeks after the operation, chemotherapy and radiation therapy were commenced. After 5 months, deep tendon reflexes recovered to normal. MRI showed that the tumor has not recurred at 29 months after surgery. CONCLUSIONS The majority of epidural patients undergo emergency surgery only after symptom exacerbation, which includes the development of neurological deficits. Thus, preoperative diagnosis of Ewing sarcoma of the epidural space is difficult and diagnosis is frequently made by a post-operative gene test. The resection area is limited to the intralesional margin area because a larger resection is difficult due to the characteristics of the affected region; thus, there is a higher possibility of recurrence and careful follow-up of the case is necessary.
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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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21
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Tural D, Molinas Mandel N, Dervisoglu S, Oner Dincbas F, Koca S, Colpan Oksuz D, Kantarci F, Turna H, Selcukbiricik F, Hiz M. Extraskeletal Ewing's sarcoma family of tumors in adults: prognostic factors and clinical outcome. Jpn J Clin Oncol 2012; 42:420-6. [PMID: 22416252 DOI: 10.1093/jjco/hys027] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate prognostic factors, survival rate and the efficacy of the treatment modalities used in patients with extraskeletal Ewing's sarcoma. METHODS Data of patients with extraskeletal Ewing's sarcoma followed up at our center between 1997 and 2010 were retrospectively analyzed. RESULTS The median age of 27 patients was 24 years (range, 16-54 years). The median follow-up was 31.8 months (range, 6-144 months). Tumor size was between 1.5 and 14 cm (median: 8 cm). Eighty-five percent of patients had localized disease at presentation and 15% had metastatic disease. Local therapy was surgery alone in 16% of patients, surgery combined with radiotherapy in 42% and radiotherapy alone in 27%. All patients were treated with vincristine, doxorubicin, cyclophosphamide and actinomycin-D, alternating with ifosfamide and etoposide every 3 weeks. In patients with localized disease at presentation, the 5-year event-free survival and overall survival were 59.7 and 64.5%, respectively. At univariate analysis, patients with tumor size ≥ 8 cm, high serum lactate dehydrogenase, metastasis at presentation, poor histological response to chemotherapy and positive surgical margin had significantly worse event-free survival. The significant predictors of worse overall survival at univariate analysis were tumor size 8 ≥ cm, high lactate dehydrogenase, metastasis at presentation, poor histological response to chemotherapy, radiotherapy only as local treatment and positive surgical margin. CONCLUSIONS Prognostic factors were similar to primary osseous Ewing's sarcomas. Adequate surgical resection, aggressive chemotherapy (vincristine, doxorubicin, cyclophosphamide and actinomycin-D alternating with ifosfamide and etoposide) and radiotherapy if indicated are the recommended therapy for patients with extraskeletal Ewing's sarcoma.
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Affiliation(s)
- Deniz Tural
- Department of Medical Oncology, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.
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Abstract
OBJECTIVE To present a case of extraskeletal Ewing's sarcoma originating in the masseter muscle, and to review the diagnosis and management of these rare tumours. METHODS Case report and literature review. RESULTS We report a patient with Ewing's sarcoma of the masseter muscle with mandibular invasion. She was treated with induction chemotherapy, salvage surgery and free flap reconstruction. CONCLUSION This case highlights the management of these rare tumours. Aggressive multi-modal treatment, including multi-agent chemotherapy, surgical resection and irradiation, appears to offer the best prognosis. Contemporary reconstructive techniques can restore function and form in cases with challenging defects.
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High Efficacy of Preoperative Low-Dose Radiotherapy with Sanazole (AK-2123) for Extraskeletal Ewing's Sarcoma: A Case Report. Sarcoma 2010; 2011. [PMID: 20871855 PMCID: PMC2943094 DOI: 10.1155/2011/185465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 08/20/2010] [Indexed: 11/17/2022] Open
Abstract
Extraskeletal Ewing's sarcoma is a rare soft tissue tumor that is morphologically indistinguishable from Ewing's sarcoma of bone. We report a case of extraskeletal Ewing's sarcoma with several systemic problems. A 69-year-old man presented with a 5-month history of a rapidly enlarging mass in the right thigh. Because preoperative radiotherapy with sanazole (AK-2123) contributed the tumor mass reduction down to 40% in size, the tumor was successfully resected with clear surgical margins and repaired with a musculocutaneous flap. The high efficacy of pre-operative low-dose radiotherapy with sanazole was histologically confirmed that the resected tumor specimen involved no viable tumor cells and showed 100% necrosis. Based on clinical outcomes in this case, the combined modality of pre-operative low-dose radiotherapy with hypoxic cell radiosensitizer and adequate surgical resection might provide for the useful clinical application of extraskeletal Ewing's sarcoma treatment.
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El Weshi A, Allam A, Ajarim D, Al Dayel F, Pant R, Bazarbashi S, Memon M. Extraskeletal Ewing's sarcoma family of tumours in adults: analysis of 57 patients from a single institution. Clin Oncol (R Coll Radiol) 2010; 22:374-81. [PMID: 20466282 DOI: 10.1016/j.clon.2010.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 02/01/2010] [Accepted: 02/23/2010] [Indexed: 02/06/2023]
Abstract
AIMS Extraskeletal Ewing's sarcoma (EES) is a rare form of soft tissue sarcoma. The aim of the present study was to assess the outcome and the prognosis of adult patients presenting with EES treated with multi-modality therapy. MATERIALS AND METHODS All EES patients older than 15 years referred to our institution between January 1995 and December 2004 were reviewed. In total, 57 patients were identified. Their median age at diagnosis was 20 years (range 15-57). RESULTS The median size of the primary tumour was 11 cm (range 4-30 cm). Eighteen patients (31%) had metastatic disease at initial presentation. Wide surgical resection with negative margins was achieved in 23 cases (40%). Chemotherapy consisting of vincristine, adriamycin, ifosfamide, actinomycin D was given in 50 patients (88%). Radiotherapy was delivered in 37 patients (65%). Forty-one patients (72%) achieved complete remission and 16 (28%) progressed on therapy. Twenty-one patients (51%) relapsed. Local recurrence was encountered in 15 patients (36%). At a median follow-up of 46 months (range 6-143 months), the 5-year event-free survival and overall survival rates were 35 and 47%, respectively. Metastases at presentation, tumour size and surgical resection margin associated significantly with overall survival and event-free survival. CONCLUSION EES is an aggressive type of tumour with a high incidence of local recurrence and distant metastasis. This series showed that the outcome of adult EES is not unlike that of skeletal Ewing's sarcoma in terms of response to multi-modality treatment and the prognostic factors influencing treatment outcome. Adequate surgical resection, aggressive chemotherapy and adjuvant local radiation therapy, when indicated, constitute the optimal treatment to achieve the best results in this rare type of disease.
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Affiliation(s)
- A El Weshi
- Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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25
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Lee JA, Kim DH, Lim JS, Koh JS, Kim MS, Kong CB, Song WS, Cho WH, Lee SY, Jeon DG. Soft-tissue Ewing sarcoma in a low-incidence population: comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Jpn J Clin Oncol 2010; 40:1060-7. [PMID: 20513751 DOI: 10.1093/jjco/hyq080] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Due to the low incidence, treatments for Korean soft tissue Ewing sarcoma patients have been heterogeneous, and reported data are limited. In this study, we retrospectively analyzed soft tissue Ewing cases treated at our institution. METHODS We analyzed the clinicopathologic characteristics and treatment outcome of soft tissue Ewing sarcoma patients and compared with those of skeletal cases. RESULTS Twenty-seven soft tissue Ewing sarcoma cases were evaluated. Patients with soft tissue Ewing sarcoma were older than patients with skeletal tumors (P = 0.03), and tended to have metastasis at diagnosis (P = 0.12). However, sex ratios, pathologies, tumor volumes, and histologic response to preoperative chemotherapy were not different in the two groups. The 5-year overall survival (49.0%) and event-free survival (45.6%) of soft tissue Ewing sarcoma patients were similar to those of skeletal tumor patients (51.8% and 46.0%, respectively). Presence of metastasis at diagnosis and poor histologic response to preoperative chemotherapy were associated with an adverse outcome for both groups. Similar to skeletal tumors, central tumor location, pathology and tumor volume tended to be related to the survival of soft tissue Ewing sarcoma. However, age and the use of a modality other than surgery to achieve local control did not influence the survival of soft tissue Ewing sarcoma patients. CONCLUSIONS Our data could provide a basis to design a collaborative or multinational study targeting Ewing sarcoma family tumors.
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Affiliation(s)
- Jun Ah Lee
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
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Torigoe T, Terakado A, Suehara Y, Kurosawa H, Yazawa Y, Takagi T. Bone versus soft-tissue sarcomas in the elderly. J Orthop Surg (Hong Kong) 2010; 18:58-62. [PMID: 20427836 DOI: 10.1177/230949901001800113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare survival rates in the elderly with bone versus soft-tissue sarcomas. METHODS Records of 12 men and 8 women aged 70 to 91 (mean, 77) years with bone or soft-tissue sarcomas were retrospectively reviewed. The grade, size, location, and stage of the sarcomas, as well as their surgical margins, treatment modalities, local recurrence, metastasis, and prognosis were recorded. The mean follow-up period was 37 (range, 2-137) months. Their 5-year survival rates were estimated using the Kaplan-Meier method, and compared with 110 younger controls aged 9 to 69 (mean, 45) years during the same period. There was no significant difference between the older patients and younger controls regarding tumour grading (p=0.068, Chi squared test), stage, and pathological diagnosis. RESULTS Six patients had bone and 14 had soft-tissue sarcomas. Of the 6 bone sarcomas, 3 were malignant fibrous histiocytomas, 2 were osteosarcomas, and one was a chordoma; all were high grade, except for the chordoma. Of the 14 soft-tissue sarcomas, 9 were malignant fibrous histiocytomas, 3 were myxofibrosarcomas, one was a liposarcoma and one an extraskeletal osteosarcoma; all were high grade except for 2 of the myxofibrosarcomas and the liposarcoma. Of the 110 younger controls, 30 had bone and 80 had soft-tissue sarcomas; 44 were low grade and 66 were high grade. The 5-year survival rate was significantly lower in older patients than in younger controls (35% vs 65%, p=0.048). Regarding bone versus soft-tissue sarcomas, the 5-year survival rate was not significantly different among older patients (0% vs 52%, p=0.068) or younger controls 61% vs 66%, p=0.863). The difference was also not significant for older patients versus younger controls with bone sarcomas (0% vs 61%, p=0.284) or soft-tissue sarcomas (52% vs 66%, p=0.368), for older patients with high- versus low-grade sarcomas 17% vs 100%, p=0.314), for older patients with sarcomas located in the limbs versus the trunk (39% vs 38%, p=0.233), as well as for older patients versus younger controls with low-grade sarcomas (100% vs 92%, p=0.512) or high-grade sarcomas (17% vs 46%, p=0.269). CONCLUSION Survival rates tend to be lower in older patients with sarcomas, especially when the sarcoma is of bone and high grade.
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Affiliation(s)
- Tomoaki Torigoe
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Abstract
Ewing sarcoma (ES) is the second most frequent primary malignant bone cancer, following osteosarcoma. ES is a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents. We describe four children aged 3, 3.5, 9, and 9.5 years, who presented with two femur masses simultaneously (patient 1), a huge mediastinal mass (patient 2), an abdomino-mediastinal mass with dysphagia (patient 3), and a huge abdomino-pelvic mass (patient 4). Our patients were of younger age and had abnormal presentations that made initial diagnosis difficult, but also are representative of the different problems encountered in pediatric practice. Biopsy initially revealed round cell tumor and by immunohistochemistry, CD99 was positive, which confirmed the diagnosis of ES. Our patients were difficult to diagnosis.The patients were misdiagnosed initially, so there was a delay in diagnosis. Definitive diagnosis required use of various radiological imaging methods and immunohistochemistry.
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Abstract
Small round cell sarcomas are the most aggressive of the tumors morphologically and clinically encountered in children and adults, and in some ways the most leukemia- or lymphoma-like of sarcomas. Small round cell sarcomas often are associated with chromosomal translocations, like hematologic malignancies, and are usually more sensitive to chemotherapy than other sarcoma subtypes. They have a high risk of mortality, but chemotherapy (in addition to surgery and often radiation therapy) provides a good cure rate, although treatment is often long and intensive. The biology of these tumors is very telling in terms of some of the mechanisms of cancer cell survival and proliferation. Although there is some overlap of the discussion below with the section on translocation associated sarcomas, we have highlighted some of the key issues with these sarcomas below, with some ideas that may bear fruit both in terms of the management of these, other sarcomas, and other cancers alike.
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Dogan S, Leković GP, Theodore N, Horn EM, Eschbacher J, Rekate HL. Primary thoracolumbar Ewing's sarcoma presenting as isolated epidural mass. Spine J 2009; 9:e9-14. [PMID: 18201936 DOI: 10.1016/j.spinee.2007.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 11/21/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ewing's sarcoma is the most common childhood malignancy of bone, but it rarely occurs as a primary extraosseous epidural tumor. PURPOSE To heighten awareness and treatment options of this rare (epidural) presentation of Ewing's sarcoma. STUDY DESIGN Case report. METHODS Retrospective review. RESULTS We present a 13-year-old boy with progressive low back and bilateral lower extremity pain and normal neurologic examination. Magnetic resonance imaging showed an extradural tumor in the dorsal epidural space from T11 to L1. He underwent a posterior laminoplasty and gross total resection of tumor; histopathological diagnosis was consistent with Ewing's sarcoma. After surgery, the patient underwent adjuvant chemotherapy and irradiation. At 10 months follow-up, the patient is neurologically intact without evidence of residual disease. CONCLUSIONS Ewing's sarcoma of the epidural space should be considered in the differential diagnosis of epidural mass lesions. Because wide surgical margins cannot be obtained, close follow-up with a low threshold for reoperation is mandatory.
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Affiliation(s)
- Seref Dogan
- Department of Neurosurgery, Uludag University, Bursa, Turkey
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31
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Extra-skeletal Ewing's sarcoma of the submandibular gland. J Plast Reconstr Aesthet Surg 2007; 60:1345-8. [DOI: 10.1016/j.bjps.2006.01.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 12/17/2005] [Accepted: 01/01/2006] [Indexed: 11/22/2022]
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Venkitaraman R, George MK, Ramanan SG, Sagar TG. A single institution experience of combined modality management of extra skeletal Ewings sarcoma. World J Surg Oncol 2007; 5:3. [PMID: 17217537 PMCID: PMC1781071 DOI: 10.1186/1477-7819-5-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 01/11/2007] [Indexed: 11/12/2022] Open
Abstract
Background Extraskeletal Ewings sarcoma are rare tumors for which there is no consensus on optimal management. Methods A retrospective review of the clinical features, treatment and outcome of patients with extraskeletal Ewings sarcoma who reported to a single institution between January 1992 – December 2003 is reported. Results A total of 19 patients with extraskeletal Ewings sarcoma were identified. Of these, 4 patients had metastatic disease at presentation and 15 patients with non-metastatic disease received combined modality treatment with primary combination chemotherapy followed by local treatment with radiotherapy or surgery. Disease free survival and overall survival for patients with non metastatic disease after combined modality treatment were 60% and 30% respectively. The significant predictors for prolonged disease free survival and overall survival were high haemoglobin(p = 0.002), low lactate dehydrogenase (p = 0.028), chemotherapy with Vincristine, Adriamycin, Cyclophosphamide, Ifosfamide and Etoposide regime (p = 0.008) and complete response to chemotherapy (p = 0.001). Conclusion Aggressive combination chemotherapy followed by complete surgery or radiotherapy to a dose of more than 50 Gy is essential to confer optimal outcome for patients with extraskeletal ewings sarcoma.
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Affiliation(s)
| | - Mathew K George
- Division of Medical Oncology, Royal Darwin Hopsital, Casuarina, Australia
| | - S Ganapathy Ramanan
- Division of Medical Oncology, Cancer Institute(WIA), Adyar, Chennai, 400036, India
| | - TG Sagar
- Division of Medical Oncology, Royal Darwin Hopsital, Casuarina, Australia
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33
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Chun JM, Kim SY, Kim JH. Ewing's sarcoma of the rotator cuff tendon: a case report. J Shoulder Elbow Surg 2006; 15:e41-3. [PMID: 17126236 DOI: 10.1016/j.jse.2005.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 10/11/2005] [Indexed: 02/01/2023]
Affiliation(s)
- Jae-Myeung Chun
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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34
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Biswas G, Hingmire S, Bagwan I, Prasad N, Bakshi A, Chinoy R, Nair C. Primitive neuroectodermal tumor (PNET) of thyroid. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ooe.2005.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Kuzucu A, Erkal HS, Soysal O, Serin M. Extraskeletal Ewing’s Sarcoma Presenting With Multifocal Intrathoracic Mass Lesions Associated With Mediastinal Shift. Ann Thorac Surg 2006; 81:1487-8. [PMID: 16564299 DOI: 10.1016/j.athoracsur.2005.03.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 03/21/2005] [Accepted: 03/29/2005] [Indexed: 11/17/2022]
Abstract
Extraskeletal Ewing's sarcoma is an uncommon disease that predominantly involves the soft tissues of the trunk or the extremities. This article presents a patient with multifocal intrathoracic mass lesions involving the mediastinum and the lingula associated with mediastinal shift, eventually diagnosed as extraskeletal Ewing's sarcoma.
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Affiliation(s)
- Akin Kuzucu
- Department of Thoracic Surgery, Inönü University Faculty of Medicine, Malatya, Turkey
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36
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Abstract
OBJECTIVE AND IMPORTANCE The Ewing's sarcoma (ES) family of tumors is a relatively rare entity, presenting most commonly in children. While the most common sites for this group of tumors are the trunk and the extremities, this case is unique in that we describe a long-term follow-up with an ES presenting in the cavernous sinus. CLINICAL PRESENTATION We report the case of a 13-year-old girl presenting with the symptoms of classic orbital apex syndrome. Magnetic resonance imaging disclosed a cavernous sinus mass engulfing the optic nerve and extending into the superior orbital fissure. INTERVENTION Evaluation of this patient included intracranial magnetic resonance imaging angiography and biopsy of the cavernous sinus mass lesion. Histopathological findings yielded a diagnosis of ES. Further work-up demonstrated that the patient's thyroid was also involved. The tumor was treated with radiation therapy to both sites and, subsequently, after confirmed metastases to other sites, 11 cycles of doxorubicin-based chemotherapy, as well as bone marrow transplantation. However, the patient succumbed to the illness 18 months after her initial diagnosis. CONCLUSION The cavernous sinus is an unusual site for ES, but given the vascularity and the frequency of this tumor in childhood, the diagnosis should be entertained. This patient with an ES of cavernous sinus may be the first reported case with a long-term follow-up in the literature.
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Affiliation(s)
- Medina Kushen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota 55455, USA
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37
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Kadri PADS, Mello PMPD, Olivera JGD, Braga FM. [Primary lumbar epidural Ewing's sarcoma: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:145-9. [PMID: 11965426 DOI: 10.1590/s0004-282x2002000100027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of a 15-years old female with an acute paraparesis secondary of an epidural mass and histopathological diagnosis was consistent with an Ewing's sarcoma without bone compromise. An exaustive literature review showed only 17 cases of primary lumbar epidural extraosseus Ewing's sarcoma.
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Affiliation(s)
- Paulo Abdo do Seixo Kadri
- Disciplina de Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
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38
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Kennedy JG, Eustace S, Caulfield R, Fennelly DJ, Hurson B, O'Rourke KS. Extraskeletal Ewing's sarcoma: a case report and review of the literature. Spine (Phila Pa 1976) 2000; 25:1996-9. [PMID: 10908947 DOI: 10.1097/00007632-200008010-00022] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVES To report on the diagnosis and current treatment of a rare tumor about the cervical spine. SUMMARY OF BACKGROUND DATA Extraskeletal Ewing's sarcoma (EES) is rare and has not been previously described about the cervical spine. We present a case of a 24-year-old man with a large mass in the posterior triangle of the neck extending through the vertebral foramens of the cervical vertebrae. This was identified as an extraskeletal Ewing's sarcoma. Traditional treatment paradigms have been associated with a poor prognosis. Since the recommendations of the Intergroup Rhabdomyosarcoma Study II study of multimodal chemotherapy and radiotherapy, this tumor has a significantly better prognosis. METHOD Surgical debulking of the tumor was necessary to relieve cord compression. Histologic analysis was used to confirm both magnetic resonance imaging and computed tomography diagnosis. A chemoradiation therapy program was commenced in accordance with Intergroup Rhabdomyosarcoma Study II recommendations. RESULTS Computed tomography and magnetic resonance imaging demonstrated a large lobulated mass extending through the exit foramens of C2/C3 and C3/C4. The mass was entirely extraskeletal and extradural. Histologic examination of the excised mass showed microscopy consistent with extraskeletal Ewing's sarcoma. After surgical debulking and chemoradiation, the patient made a complete recovery. CONCLUSION A review of the literature confirms that extraskeletal Ewing's sarcoma is a rare tumor and particularly so in the region of the cervical spine. Early diagnosis and surgical debulking combined with current multimodality chemoradiation programs can produce a favorable outcome.
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Affiliation(s)
- J G Kennedy
- Departments of Orthopaedic Surgery, St. Vincent's Hospital, Elm Park, Dublin, Ireland
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39
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Benesch M, Urban C, Lackner H, Kerbl R, Schwinger W, Beham-Schmid C, Ratschek M, Oberbauer R. Atypical extraosseous Ewing sarcoma of the spinal canal with bone marrow involvement in a two-month-old boy. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:471-3. [PMID: 10358716 DOI: 10.1002/(sici)1096-911x(199906)32:6<471::aid-mpo22>3.0.co;2-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M Benesch
- Department of Pediatrics, University of Graz, Austria.
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41
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Abstract
BACKGROUND Although fine-needle aspiration biopsy (FNAB) of primary skeletal osteosarcoma (OS) has been described adequately, to the authors' knowledge, cytologic descriptions of extraskeletal OS appear limited to only rare case reports. METHODS In an attempt to analyze the utility and accuracy of FNAB in a diagnosis of skeletal versus extraskeletal OS, the authors retrospectively reviewed their 5-year experience. The study sample included 15 skeletal OS specimens (13 primary, 1 local recurrence, and 1 pulmonary metastasis) in 14 patients ages 10-58 years (mean, 27 years; median, 25 years) and 5 extraskeletal OS specimens (3 primary and 2 metastatic) in 4 patients ages 36, 37, 65, and 79 years, respectively. Based on accepted clinical criteria, two patients (a mother with extraskeletal OS and a daughter with skeletal OS) had Li-Fraumeni syndrome. RESULTS Of the adequate primary skeletal OS cases analyzed by FNAB, 10 of 12 (83%) were diagnosed correctly and subsequently treated according to a disease specific protocol. One case was considered unsatisfactory. One tumor initially was diagnosed as a giant cell tumor and another was referred to nonspecifically as "spindle-cell neoplasm." On histologic examination, the former case demonstrated a high grade fibroblastic OS arising within a giant cell tumor. None of the primary extraskeletal OS cases analyzed by FNAB was recognized as OS. One was diagnosed nonspecifically as "sarcoma" and the other was referred to simply as "atypical mesenchymal cells." A third case was comprised of scant fragments of adipose tissue, fibrous tissue, and cartilage and was considered unsatisfactory. Both examples of metastatic extraskeletal OS were recognized by FNAB. CONCLUSIONS With appropriate clinicoradiologic correlation, skeletal OS generally is easily diagnosed by FNAB. Because of the older age of most patients with extraskeletal OS and the rather nonspecific radiographic findings (e.g., soft tissue mass), extraskeletal OS may not be recognized easily by FNAB and most likely requires incisional biopsy to establish a definitive diagnosis in most cases. Additional larger series will be required before drawing definite conclusions.
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Affiliation(s)
- K K Nicol
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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42
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Christie DR, Bilous AM, Carr PJ. Diagnostic difficulties in extraosseous Ewing's sarcoma: a proposal for diagnostic criteria. AUSTRALASIAN RADIOLOGY 1997; 41:22-8. [PMID: 9125062 DOI: 10.1111/j.1440-1673.1997.tb00463.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Five cases diagnosed as extraosseous Ewing's sarcoma (EES) during a 15-year period, and the relevant literature, were reviewed. The diagnosis in these cases was difficult to confirm, mainly because the distinction between the osseous form of Ewing's sarcoma (OES) and either periosteal reactions or direct tumour invasion into adjacent bone by EES was often unclear. The literature suggests that other authors have also encountered difficulties. The authors believe that many cases reported as EES are likely to have been OES. This distinction has some importance, as the two conditions are usually treated in differing ways. The following criteria are proposed for the diagnosis of primary EES: (i) no evidence of bony involvement on magnetic resonance imaging; (ii) no evidence of increased uptake in bone or periosteum adjacent to the tumour on static isotope bone scan images; (iii) a small round cell tumour with no differentiating features on light microscopy, immunochemistry or electron microscopy; and (iv) demonstration of cytoplasmic glycogen.
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Affiliation(s)
- D R Christie
- Department of Radiation Oncology, Westmead Hospital, New South Wales, Australia
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43
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Siebenrock KA, Nascimento AG, Rock MG. Comparison of soft tissue Ewing's sarcoma and peripheral neuroectodermal tumor. Clin Orthop Relat Res 1996:288-99. [PMID: 8769464 DOI: 10.1097/00003086-199608000-00036] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thirty-four cases with either extraskeletal Ewing's sarcoma (21 patients) or malignant peripheral neuroectodermal tumor of the soft tissues (13 patients) were reviewed retrospectively. The patients were treated between 1964 and 1991. Followup periods averaged 7.2 years for patients with peripheral neuroectodermal tumors and 10.4 years for patients with Ewing's sarcoma (minimal followup of 2 years). There were no significant differences in patient's age, gender, tumor location, and stages on presentation between patients with Ewing's sarcoma and those with malignant peripheral neuroectodermal tumor of the soft tissue. All but 2 patients underwent surgery for tumor resection. Adjunctive therapy (radiation or chemotherapy or both) was administered in 95% of the patients with Ewing's sarcoma and in 85% of the patients with peripheral neuroectodermal tumors. The 5-year overall survival was 50% for Ewing's sarcoma and 44% for peripheral neuroectodermal tumor. The 5-year disease free survival was 33% for both types of tumors. Survival rates were higher for Stage III compared with Stage IV disease for both types of tumors. There was a tendency for better outcome after complete surgical tumor resection. Survivors tended to be of a younger age at the time of tumor diagnosis. The results suggest that from a clinical perspective, these 2 tumors are quite similar.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Agents/therapeutic use
- Bone Neoplasms/mortality
- Bone Neoplasms/pathology
- Bone Neoplasms/therapy
- Chemotherapy, Adjuvant
- Child
- Child, Preschool
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Staging
- Neuroectodermal Tumors, Primitive, Peripheral/mortality
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Radiotherapy, Adjuvant
- Retrospective Studies
- Sarcoma, Ewing/mortality
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/therapy
- Soft Tissue Neoplasms
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- K A Siebenrock
- Department of Orthopaedics, University of Bern, Switzerland
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44
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Abstract
Extraosseous Ewing's sarcoma is an extremely rare neoplasm that may occur in the lower extremity. The neoplasm is highly aggressive and is usually fatal, however, early diagnosis and treatment greatly increase the chances of survival. A case report and review of the literature is presented.
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Affiliation(s)
- R A Berliner
- Department of Surgery, Beth Israel Hospital, Passaic, New Jersey, USA
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45
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Abstract
Although uncommon, primary and metastatic neoplasms can occur in the chest wall. For malignant neoplasms, the potential for cure depends on the completeness of resection, histologic type, and tumor stage. Each patient warrants individual evaluation for chest wall resection. Operative selection is based on the potential benefits, operative feasibility, patient health, and anticipated tumor biology. The choice of reconstruction techniques is based on the tumor's location, the size of the remaining defect, and the availability of autogenous graft materials. Skeletal and soft tissue reconstruction can be performed safely in a single stage.
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Affiliation(s)
- B O Anderson
- Department of Surgery, University of Washington School of Medicine, Seattle
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46
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Stechschulte SU, Kepes JJ, Holladay FP, McKittrick RJ. Primary Meningeal Extraosseous Ewing??s Sarcoma. Neurosurgery 1994. [DOI: 10.1097/00006123-199407000-00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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47
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Stechschulte SU, Kepes JJ, Holladay FP, McKittrick RJ. Primary meningeal extraosseous Ewing's sarcoma: case report. Neurosurgery 1994; 35:143-7. [PMID: 7936137 DOI: 10.1227/00006123-199407000-00023] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 25-year-old man presented with a suspected right-sided subdural hematoma after a skiing accident. A large hemorrhagic mass was found and was evacuated. Histological studies demonstrated a highly cellular neoplasm with extensive hemorrhage. Further histological, immunohistochemical (including staining for Ewing's sarcoma cell surface antigen), and ultrastructural analyses of the tumor were consistent with Ewing's sarcoma. Search for other foci of this neoplasm by bone scan, full body computed tomographic scans, magnetic resonance imaging scans of the spine, and a bone marrow aspiration with biopsy failed to detect any soft tissue or bony involvement outside the cranium. This case appears to represent the first report of a primary extraosseous Ewing's sarcoma occupying the cranial subdural area.
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Affiliation(s)
- S U Stechschulte
- Department of Medicine, University of Kansas Medical Center, Kansas City
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48
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Abstract
The case of a 7-year-old boy with a spinal epidural extraosseous Ewing's sarcoma (EES) is presented. He is in complete remission without neurologic deficit 40 months after diagnosis. Another 15 cases were found in the literature and are discussed together with this patient. Twelve of them were male patients. The mean age of the patients was 17.5 years (range, 4 to 47). Symptoms included back pain and/or radicular pain (100%), paresis of one or both legs (83%), sensory disturbances, and bladder and bowel dysfunction. The mean diagnostic delay was 5.8 months. Each patient underwent laminectomy; complete resection of the tumor was impossible in more than 50% of the cases. Most patients received radiation therapy and/or chemotherapy. Four patients suffered from local recurrence, eight from metastases. Ten (63%) patients died, 1 to 48 months (mean, 16) after diagnosis. The differential diagnosis is discussed, including disk herniation and several benign and malignant tumors.
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Affiliation(s)
- G J Kaspers
- Department of Pediatrics, Free University Hospital, Amsterdam, The Netherlands
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49
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50
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Llombart-Bosch A, Carda C, Peydro-Olaya A, Noguera R, Perez-Bacete M, Pellin A, Boix J. Soft tissue Ewing's sarcoma. Characterization in established cultures and xenografts with evidence of a neuroectodermic phenotype. Cancer 1990; 66:2589-601. [PMID: 1701108 DOI: 10.1002/1097-0142(19901215)66:12<2589::aid-cncr2820661223>3.0.co;2-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study characterizes the histogenesis of soft tissue Ewing's sarcoma (StEs) based upon an analysis of three tumors. Long-term cultured cell lines and nude mice xenografts were established from original neoplasms or from their metastases. Histologically they revealed a small round cell pattern without signs of differentiation. Several ultrastructural features of neural type were found; the same were also seen on culture cell lines. Moreover, immunohistochemical study for neural markers revealed the presence of HNK-1, NSE, LIRC-LON 36, S-100 protein, glial fibrillary acidic protein, neurofilaments (70 kilodaltons), and chromogranin; some of these markers were present only in the transplants. Cytokeratin was also seen. The translocation t(11;22)(q24;q12) was found in all three neoplasms together with other chromosomal abnormalities. N-myc RNA gave negative results whereas c-myc RNA was expressed. Therefore it may be postulated that StEs displays neuroectodermal features somewhat similar to those seen in peripheral neuroepithelioma as well as in atypical Ewing's sarcoma of bone.
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MESH Headings
- Adolescent
- Adult
- Animals
- Antigens, Differentiation/analysis
- CD57 Antigens
- Chromogranins/analysis
- Female
- Glial Fibrillary Acidic Protein/analysis
- Humans
- Intermediate Filament Proteins/analysis
- Karyotyping
- Male
- Membrane Proteins/analysis
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Neoplasm Transplantation
- Neoplasms, Germ Cell and Embryonal/chemistry
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/pathology
- Phosphopyruvate Hydratase/analysis
- Proto-Oncogene Proteins c-myc/analysis
- S100 Proteins/analysis
- Sarcoma, Ewing/chemistry
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Soft Tissue Neoplasms/chemistry
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Synaptophysin
- Tumor Cells, Cultured/chemistry
- Tumor Cells, Cultured/pathology
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Affiliation(s)
- A Llombart-Bosch
- Department of Pathology, Medical School, University of Valencia, Spain
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