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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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Dai J, He HC, Huang X, Sun FK, Zhu Y, Xu DF. Long-term survival of a patient with a large adrenal primitive neuroectodermal tumor: A case report. World J Clin Cases 2019; 7:340-346. [PMID: 30746375 PMCID: PMC6369397 DOI: 10.12998/wjcc.v7.i3.340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/11/2018] [Accepted: 11/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adrenal primitive neuroectodermal tumor (PNET) is an extremely rare malignant tumor with poor prognosis and of neural crest origin. Herein, we report a case of adrenal PNET and summarized its clinical and pathological characteristics on the basis of 16 patients reported recently.
CASE SUMMARY A female patient aged 25 years presented with right lumbago for 12 mo, and pre-operative computed tomography showed a huge right adrenal mass. She received tumorectomy, and post-operative pathological examination showed adrenal PNET. After surgery, she underwent adjuvant chemotherapy and was followed up 31 mo after surgery. She received brachytherapy for right paracolic and hepatic metastases. She was alive and followed up for 60 mo. In available studies, only 57.14% (4/7) and 44.44% (4/9) were positive for the expression of neuron-specific enolase and synaptophysin, respectively, although CD99 expression was found in all the patients (100%; 10/10).
CONCLUSION It is concluded that adrenal PNET is very rare and highly malignant, and histology is a golden standard in its diagnosis. Surgery and adjuvant therapy is the main treatment.
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Affiliation(s)
- Jun Dai
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Hong-Chao He
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Xin Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Fu-Kang Sun
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Yu Zhu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Dan-Feng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
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3
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Eddaoualline H, Mazouz K, Rafiq B, El Mghari Tabib G, El Ansari N, Belbaraka R, El Omrani A, Khouchani M. Ewing sarcoma of the adrenal gland: a case report and review of the literature. J Med Case Rep 2018; 12:69. [PMID: 29544549 PMCID: PMC5855992 DOI: 10.1186/s13256-018-1601-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/01/2018] [Indexed: 01/10/2023] Open
Abstract
Background Ewing sarcoma/primitive neuroectodermal tumor is a family of highly malignant proliferation of neuroectodermal origin, most often skeletal, adrenal localization is extremely rare. Only few cases have been reported in the literature. Classical management includes radical surgery with adjuvant chemotherapy or radiotherapy or both. This case report is the only one where recurrence was surgically removed, and it confirms the importance of adjuvant treatment, and the efficacy of neoadjuvant chemotherapy. Case presentation We report the case of a 23-year-old Moroccan woman presenting with flank pain. An abdominal computed tomography scan showed a large and enhancing left suprarenal mass. After radical nephrectomy, histologic examination revealed a small round cell proliferation. The diagnosis of Ewing sarcoma was confirmed by molecular analysis; time to final diagnosis was 5 months due to financial and coordination issues. Computed tomography (on an asymptomatic patient) revealed a locoregional recurrence, our patient received 12 cycles of the vincristine, doxorubicin and cyclophosphamide/ifosfamide and etoposide protocol used in an alternating schedule, with partial radiologic response (62%) and pathologic complete response, then underwent adjuvant radiotherapy of 45 Gy. The young women is still in remission after 36 months of follow-up. Conclusions Our patient had an early recurrence due to absence of adjuvant treatment, but did respond well to neoadjuvant chemotherapy with a pathologic complete response. Management of adrenal Ewing sarcoma could be extrapolated from skeletal one with good outcomes even in locoregional recurrence.
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Affiliation(s)
- Hanane Eddaoualline
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco.
| | - Khadija Mazouz
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Bouchra Rafiq
- Endocrinology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | | | - Nawal El Ansari
- Endocrinology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Rhizlane Belbaraka
- Medical Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Abdelhamid El Omrani
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Mouna Khouchani
- Radiation Oncology Department, Mohammed VI University Hospital, Marrakech, Morocco
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Toda K, Ishii S, Yasuoka H, Nishioka M, Kobayashi T, Horiguchi K, Tomaru T, Ozawa A, Shibusawa N, Satoh T, Koshi H, Segawa A, Shimizu SI, Oyama T, Yamada M. Adrenal Ewing's Sarcoma in an Elderly Man. Intern Med 2018; 57:551-555. [PMID: 29269639 PMCID: PMC5849552 DOI: 10.2169/internalmedicine.8892-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ewing's sarcoma usually arises in the bones of children and adolescents. We herein report a 74-year-old man with Ewing's sarcoma in the adrenal gland. The diagnosis was confirmed by a genetic test, pathological studies, and several imaging studies. He already had multiple liver metastases when he was transferred to our hospital and died on the 37th day. The diagnosis was further confirmed by autopsy studies. Adrenal Ewing's sarcoma is very rare, and our patient was older than other reported cases. Ewing's sarcoma should be considered even in elderly patients with adrenal tumors.
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Affiliation(s)
- Kazuyoshi Toda
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Sumiyasu Ishii
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Hidetoshi Yasuoka
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Masaki Nishioka
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Takayuki Kobayashi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Kazuhiko Horiguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Takuya Tomaru
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Atsushi Ozawa
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Nobuyuki Shibusawa
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Tetsurou Satoh
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Hiromi Koshi
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Japan
| | - Atsuki Segawa
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Japan
| | - Shin-Ichi Shimizu
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
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Guo H, Chen S, Liu S, Wang K, Liu E, Li F, Hou Y. Rare adrenal gland incidentaloma: an unusual Ewing's sarcoma family of tumor presentation and literature review. BMC Urol 2017; 17:24. [PMID: 28376845 PMCID: PMC5379633 DOI: 10.1186/s12894-017-0217-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/27/2017] [Indexed: 01/10/2023] Open
Abstract
Background Members of the Ewing’s sarcoma family of tumor (ESFT) are malignant neoplasms and rarely observed in the adrenal gland. Case presentation We report an extremely exceptional case of ESFT rising from the adrenal gland in a 57-year-old Chinese man. The patient was hospitalized with abdominal swelling for 2 months. Computed tomography (CT) scan revealed a nearly-circular mass measuring about 8.1 × 10.6 cm in the right adrenal region. The patient underwent right adrenal resection. Histopathologic examination found the tumor was composed of small round blue cells forming typical Homer-Wright rosettes in focal area. The immunohistochemical analysis confirmed the case to be ESFT, which was positive for membranous CD99 and nuclear FLI-1. The patient was scheduled for four courses of large doses of chemotherapy and died for cancer metastasis one year later after surgery. Conclusions Histopathological evidence of Homer-Wright rosettes and immunohistochemical markers positivity, such as CD99 and FLI-1, are valuable factors for ESFT diagnosis, although cytogenetic analysis is considered as the gold standard. Complete surgery is the treatment of choice for ESFT and adjuvant radiotherapy and combination chemotherapy can significantly improve the survival rate of postoperative patients.
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Affiliation(s)
- Hui Guo
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Shuaiqi Chen
- Department of Urology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, 453100, China
| | - Shukun Liu
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Kaixuan Wang
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Erpeng Liu
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Faping Li
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yuchuan Hou
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin, 130021, China.
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Pal DK, Chandra V, Ranjan KR, Chakrabortty D, Banerjee M. Ewing's Sarcoma of the Adrenal Gland. APSP J Case Rep 2016; 7:20. [PMID: 27398321 PMCID: PMC4921217 DOI: 10.21699/ajcr.v7i3.406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/28/2016] [Indexed: 12/27/2022] Open
Abstract
Ewing’s sarcoma (ES) or primitive neuro-ectodermal tumor (PNET) typically occurs in long or flat bones, the chest wall, extra-skeletal soft tissue, and rarely in solid organs. Incidence of adrenal Ewing’s sarcoma is very rare. Here we report a case of Ewing’s sarcoma of the right adrenal gland in an 8-year-old girl who presented with an abdominal mass. The huge tumor was managed by preoperative neo-adjuvant chemotherapy followed by surgical resection. She died due to metastasis after five months of surgery.
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Affiliation(s)
- Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata
| | - Vipin Chandra
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata
| | - Kumar Rajiv Ranjan
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata
| | - Debasis Chakrabortty
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata
| | - Manju Banerjee
- Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata
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7
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Esch L, Barski D, Bug R, Otto T. Prostatic sarcoma of the Ewing family in a 33-year-old male - A case report and review of the literature. Asian J Urol 2015; 3:103-106. [PMID: 29264173 PMCID: PMC5730813 DOI: 10.1016/j.ajur.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 01/29/2023] Open
Abstract
Ewing sarcoma is the second most common primary bone tumor seen in children and adolescents, typically presenting between 10 and 20 years of age. Extraosseous sarcomas of the Ewing family in adults are rare. We report a manifestation of this tumor entity in the periprostatic tissue of a 33-year-old male and discuss our treatment approach. Transrectal biopsy is a feasible and simple diagnostic tool for unclear pelvic masses. Multi-modal therapy and central registries are needed to gain knowledge of rare pelvic tumors like Ewing sarcoma.
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Affiliation(s)
- Lukas Esch
- Department of Urology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Dimitri Barski
- Department of Urology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Reinhold Bug
- Department of Pathology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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8
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Shibuya T, Mori K, Sumino Y, Sato F, Mimata H. Rapidly progressive primitive neuroectodermal tumor of the prostate: A case report and review of the literature. Oncol Lett 2014; 9:634-636. [PMID: 25624891 PMCID: PMC4301542 DOI: 10.3892/ol.2014.2731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023] Open
Abstract
The present study reports a rare case of primitive neuroectodermal tumor (PNET) of the prostate. A 23-year-old male presented to Oita Medical Center (Oita, Japan) with the complaint of dysuria and anal pain. A large mass in the prostate and a number of swollen lymph nodes in the pelvic region were identified by a computed tomography scan and magnetic resonance imaging. The patient was, thus, admitted to Oita University Hospital (Yufu, Japan), where a biopsy of the prostate gland was performed. Histological analysis revealed small round cells that were positive for MIC-2 expression and fluorescent in situ hybridization analysis detected a translocation involving Ewing sarcoma breakpoint region 1 at chromosome 22q12. Thus, a diagnosis of PNET of the prostate was established. Systemic chemotherapy was the selected treatment, however, a poor response was obtained. The patient succumbed approximately four months after the initial onset of symptoms. PNET of the prostate has been reported in eight cases worldwide; in comparison, the present case exhibited the most unsatisfactory outcome.
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Affiliation(s)
- Tadamasa Shibuya
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Kenichi Mori
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Yasuhiro Sumino
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Fuminori Sato
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Hiromitsu Mimata
- Department of Urology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
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