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Carter ME, Benegiamo-Chilla A, Kloker LD, Paulsen N, Potkrajcic V, Paulsen F, Nemeth A, Steger V, Schulze M, Biskup S, Benzler K, Singer S, Lauer UM, Zender L, Deinzer CKW. Case report: Pulmonary Ewing sarcoma disguised as non-small cell lung cancer. Front Oncol 2024; 14:1449119. [PMID: 39575427 PMCID: PMC11578818 DOI: 10.3389/fonc.2024.1449119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 10/11/2024] [Indexed: 11/24/2024] Open
Abstract
Ewing sarcoma is the second most common primary malignant bone cancer in children and adolescents. This rare type of cancer is characterized by its high malignancy and therefore high risk of metastases. Typically, Ewing sarcomas originate from bones. However, extraosseous Ewing sarcoma such as pulmonary Ewing sarcoma can also be found. In this case report, we present a 55-year old male patient who was initially diagnosed with non-small cell lung cancer at his local district hospital. However, the diagnosis was changed to one of pulmonary Ewing sarcoma after subsequent histopathological and molecular pathological analysis performed in a reference pathology laboratory. After patient referral to a certified (according to the German Cancer Society) high-volume sarcoma center, multimodal chemotherapy was initiated based on recently published clinical data as opposed to the more commonly used treatment regimen in Europe. The patient responded well to treatment and underwent a complete surgical tumor resection followed by radiotherapy. In summary, this case report highlights the importance of a rigorous and timely histopathological examination of biopsy samples by a specialized cancer center to enable a correct diagnosis of the cancer type. Additionally, molecular pathology plays a crucial part in this analysis and allows the necessary differentiation between cancer types. Up to now, there is no international treatment guideline available for the treatment of Ewing sarcoma. Patients should be referred to specialist centers to allow the best possible treatment of the cancer type in view of current published clinical data. In the case of Ewing sarcoma, and in accordance with the most recent research, patients should be treated with vincristine, doxorubicin and cyclophosphamide plus ifosfamide and etoposide in combination with local treatment such as surgery and/or radiotherapy because this has been demonstrated to be the more effective therapy.
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Affiliation(s)
- Mary E. Carter
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
| | | | - Linus D. Kloker
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
| | - Nikolas Paulsen
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
| | - Vlatko Potkrajcic
- Department of Radiation Oncology, University Hospital, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital, Tübingen, Germany
| | - Attila Nemeth
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Tübingen, Germany
| | - Volker Steger
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Tübingen, Germany
| | | | - Saskia Biskup
- Zentrum für Humangenetik Tübingen, Tübingen, Germany
- CeGaT GmbH, Center for Genomics and Transcriptomics, Tübingen, Germany
| | - Katrin Benzler
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
| | - Stephan Singer
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrich M. Lauer
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
- University of Tübingen, iFIT Cluster of Excellence (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Tübingen, Germany
- German Cancer Research Consortium (DKTK), Partner Site Tübingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lars Zender
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
- University of Tübingen, iFIT Cluster of Excellence (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Tübingen, Germany
- German Cancer Research Consortium (DKTK), Partner Site Tübingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph K. W. Deinzer
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tübingen, Germany
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Fedeli MA, Marras V, Fara AM, Deiana A, Lobrano R, Cossu A, Paliogiannis P. Primary Ewing sarcoma of the lung: A systematic review of the recent literature. Ann Diagn Pathol 2023; 65:152152. [PMID: 37149954 DOI: 10.1016/j.anndiagpath.2023.152152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
Primary pulmonary Ewing sarcoma (PES) is a rare malignancy with only sporadic cases reported in the scientific literature. We performed a systematic review of the cases published in the last decade on PubMed, with the aim to describe the clinical, pathological, therapeutic, and prognostic data of PES. Forty-two articles reporting on 50 cases have been reviewed. Globally, 60 % of the patients were males, and the mean age at diagnosis was 30.5 years, with only a few cases diagnosed after 50 years of age. The most common clinical manifestations at diagnosis were dyspnea, cough and chest pain. The most common immunohistochemistry findings were staining for CD99 and (less frequently) for vimentin, and no staining for TTF-1, cytokeratin, desmin and S-100. ESWR1-FL1 translocation was tested in less than half of the cases. The disease was often locally advanced, treated generally with multidisciplinary treatment combining surgery, chemotherapy and radiation therapy. Among patients with follow-up data, approximately 40 % were dead at the time of publication, with the median survival being 11.5 months. Among those who were alive, only 8.3 % was free from disease at 48 months from diagnosis.
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Affiliation(s)
- Maria Antonietta Fedeli
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Vincenzo Marras
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Antonella Maria Fara
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Angelo Deiana
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy
| | - Renato Lobrano
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
| | - Antonio Cossu
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
| | - Panagiotis Paliogiannis
- Unit of Anatomic Pathology and Histology, University Hospital of Sassari (A.O.U. SS), Via Matteotti 60, 07100 Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
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3
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Primary pleuro-pulmonary Ewing's sarcoma: multimodal approach with uniportal thoracoscopic resection. Indian J Thorac Cardiovasc Surg 2023; 39:178-181. [PMID: 36471861 PMCID: PMC9713175 DOI: 10.1007/s12055-022-01432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022] Open
Abstract
Primitive neuroectodermal tumors (PNETs) and Ewing's sarcoma (ES) belong to the same family of malignant, small, round cell neoplasms of soft tissue or bone origin. With just around 30 cases reported so far, primary pleuro-pulmonary PNETs/ES are extremely rare in adults. We herein describe a case of a hexagenerian male diagnosed with primary pleuro-pulmonary PNETs/ES after tissue biopsy. He underwent neoadjuvant chemotherapy, and after significant downstaging of the tumor, he underwent complete resection of the lesion through uniportal video-assisted thoracoscopic surgery (u-VATS) followed by adjuvant chemo-radiotherapy. He was disease-free while under close follow-up for the past 1 year.
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Tsetsou I, Moschouris H, Spanomanolis N, Soumpourou E. Ewing Sarcoma of the Lung: Imaging of a Rare Tumor. Cureus 2022; 14:e32395. [PMID: 36636530 PMCID: PMC9830843 DOI: 10.7759/cureus.32395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Primary pulmonary Ewing sarcoma is an extremely rare tumor of neuroectodermal tissue. In this article, we report on the case of a 45-year-old female who presented in the emergency department with shortness of breath and night fever. Radiologic findings suggested a massive pulmonary mass and a metastatic liver lesion. The diagnosis of Ewing sarcoma was established through a percutaneous biopsy of the lung mass and liver lesion. We highlight the importance of considering a broad differential diagnosis for a large pulmonary mass in order to lead to a prompt diagnosis and treatment.
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Affiliation(s)
- Ilianna Tsetsou
- Department of Radiology, Tzaneio General Hospital of Piraeus, Piraeus, GRC
| | - Hippocrates Moschouris
- Department of Interventional Radiology, Tzaneio General Hospital of Piraeus, Piraeus, GRC
| | | | - Evridiki Soumpourou
- 2nd Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus, GRC
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Wright A, Desai M, Bolan CW, Badawy M, Guccione J, Rao Korivi B, Pickhardt PJ, Mellnick VM, Lubner MG, Chen L, Elsayes KM. Extraskeletal Ewing Sarcoma from Head to Toe: Multimodality Imaging Review. Radiographics 2022; 42:1145-1160. [PMID: 35622491 DOI: 10.1148/rg.210226] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare subtype in the Ewing sarcoma family of tumors (ESFT), which also includes Ewing sarcoma of bone (ESB) and, more recently, primitive neuroectodermal tumors. Although these tumors often have different manifestations, they are grouped on the basis of common genetic translocation and diagnosis from specific molecular and immunohistochemical features. While the large majority of ESFT cases occur in children and in bones, approximately 25% originate outside the skeleton as EES. Importantly, in the adult population these extraskeletal tumors are more common than ESB. Imaging findings of EES tumors are generally nonspecific, with some variation based on location and the tissues involved. A large tumor with central necrosis that does not cross the midline is typical. Despite often nonspecific findings, imaging plays an important role in the evaluation and management of ESFT, with MRI frequently the preferred imaging modality for primary tumor assessment and local staging. Chest CT and fluorine 18 fluorodeoxyglucose PET/CT are most sensitive for detecting lung and other distant or nodal metastases. Management often involves chemotherapy with local surgical excision, when possible. A multidisciplinary treatment approach should be used given the propensity for large tumor size and local invasion, which can make resection difficult. Despite limited data, outcomes are similar to those of other ESFT cases, with 5-year survival exceeding 80%. However, with metastatic disease, the long-term prognosis is poor. ©RSNA, 2022.
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Affiliation(s)
- Alexandra Wright
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Madhura Desai
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Candice W Bolan
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Mohamed Badawy
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Jeffrey Guccione
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Brinda Rao Korivi
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Perry J Pickhardt
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Vincent M Mellnick
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Meghan G Lubner
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Longwen Chen
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Khaled M Elsayes
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
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Thomas A, Obeidat N, Darweesh M. Thoracic Ewing’s Sarcoma: A Case Report. Cureus 2022; 14:e24150. [PMID: 35592195 PMCID: PMC9110040 DOI: 10.7759/cureus.24150] [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] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Ewing’s sarcoma family of tumors (ESFTs) contains multiple tumors with similar histological and immunohistochemical features. ESFTs are small, round cell, highly malignant tumors that arise from the neuroectoderm of bone and extraskeletal soft tissue. Ewing’s sarcoma is the second most common primary malignant bone cancer in children and adolescents, with the second decade of life being the most common age of diagnosis. In this article, we present a case of a young male who presented to the emergency department complaining of shortness of breath and cough and was later diagnosed with Ewing’s sarcoma of the chest wall, which is also called Askin’s tumor, and it is an extremely rare disease with only 17 cases reported in the literature.
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7
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Zhu W, Yang X, Zeng J, Wei M, Wang S, Li W. Extraskeletal Ewing sarcoma of thyroid gland: A case report. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:558-564. [PMID: 34148894 PMCID: PMC10930210 DOI: 10.11817/j.issn.1672-7347.2021.200161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Indexed: 11/03/2022]
Abstract
Extraskeletal Ewing sarcoma is a rare event, and extraskeletal Ewing sarcoma of the thyroid gland is even rarer. It has non-specific clinical manifestation and difficulty in early diagnosis. The diagnosis mainly depends on histology and immunohistochemistry. It possesses the features of high malignancy, high rate of local recurrence, and distant metastasis. Currently, the aggressive multimodal treatment contains surgery, chemotherapy, and radiotherapy. This study presented a case of extraskeletal Ewing sarcoma arising in the thyroid gland of a 30-year-old woman, who presented with supraclavicular mass and sense of dysphagia obstruction in Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University in 2018. Imaging studies demonstrated a cystic-solid mass in inferior of the left leaf of thyroid gland and in the posterior of the trachea and esophagus. The patient underwent localized tumor resection. The pathological diagnosis revealed that it was a small round cell tumor, and the immunohistochemistry results were considered to be extraskeletal Ewing sarcoma. Subsequently, the patient was given chemotherapy and local radiation therapy. There was no evidence of tumor recurrence or metastasis.
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Affiliation(s)
- Weiyu Zhu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116.
| | - Xinming Yang
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Junjie Zeng
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011
| | - Minghui Wei
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116
| | - Shuang Wang
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
| | - Wencheng Li
- Department of Otolaryngology, Head and Neck Surgery, Anhua People's Hospital, Yiyang Hunan 413500, China
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Ling X, Tong J, Wang L, Yao C, Chen Z. Primary pulmonary Ewing's sarcoma: rare cause of massive hemothorax in a young girl-case report. BMC Pediatr 2021; 21:194. [PMID: 33888082 PMCID: PMC8061173 DOI: 10.1186/s12887-021-02672-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ewing's sarcoma is a common malignant bone tumor in children and young adults. Rarely, extra-skeletal soft tissues and visceral organs can also be the site of origin of Ewing's sarcoma. Primary pulmonary Ewing's sarcoma is an extremely rare malignancy. CASE PRESENTATION We report an unusual case of primary pulmonary Ewing's sarcoma in a 15-year-old girl who initially presented with massive hemothorax. By histopathology evaluation of surgical biopsy specimens, the diagnosis of extraosseous Ewing's sarcoma was confirmed by both light microscopy and immunohistochemistry. Emergency, open surgery was performed by thoracic surgery at an early stage. After 3 cycles of chemotherapy, the patient was found to be stable at follow-up examination. No more hydrothorax or other symptoms. CONCLUSIONS We have described an extremely rare case of primary pulmonary Ewing's sarcoma with massive hemothorax. The patient underwent surgical resection and postoperative chemotherapy, no sign of recurrence to date as an outcome.
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Affiliation(s)
- Xuefeng Ling
- Respiratory Medicine Department, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, China
| | - Jianlin Tong
- Respiratory Medicine Department, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, China
| | - Liangliang Wang
- Pathology Department, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, China
| | - Chuan Yao
- Cardio-thoracic Surgical Department, Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, China
| | - Zhiying Chen
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, Jiangxi, China.
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Veselis CA, Awan O, Thomas A, Ling S, Jonnalagadda P, Aneja A, Ali S. Bone Tumors Occurring in the Soft Tissues: A Review of the Clinical, Imaging, and Histopathologic Findings. Curr Probl Diagn Radiol 2020; 50:419-429. [PMID: 32665061 DOI: 10.1067/j.cpradiol.2020.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022]
Abstract
Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a well-defined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.
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Affiliation(s)
| | - Omer Awan
- University of Maryland School of Medicine. Baltimore, MD
| | | | | | | | | | - Sayed Ali
- Temple University Hospital. Philadelphia, PA
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Wu HH, Wingfield-Digby J, Jifon G. Primary Ewing sarcoma of the lung: a challenging case. J R Coll Physicians Edinb 2020; 50:141-143. [PMID: 32568284 DOI: 10.4997/jrcpe.2020.212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025] Open
Abstract
Ewing sarcoma usually develops in the second decade of life as a primary osseous malignancy. An extraskeletal primary source of this condition from the lung parenchyma is extremely uncommon. We report the case of a 33-year old man with primary Ewing sarcoma of the lung diagnosed upon postsurgical histological examination. Initially presenting with unilateral pleural effusion, our patient underwent various investigations before final diagnosis. This case report reviews the available literature of similarly reported cases and discusses the current developments on managing this rare and aggressive disease. As a supplementary learning point, this case reminds us always to consider unusual possibilities and seek further sub-specialist opinion when presented with unresolved clinical and radiological abnormalities that require further exploring beyond the primary line of investigations and treatment.
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Affiliation(s)
- Henry H Wu
- Faculty of Biology, Medicine and Health University of Manchester, Oxford Road, M13 9PT, UK
| | - James Wingfield-Digby
- Department of Respiratory Medicine, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust
| | - Gilbert Jifon
- Department of Respiratory Medicine, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust
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Ibabao C, Tsetse C, Sheth Y, Maitland C, Mohammed M. Primary Ewing sarcoma of the adrenal gland: A rare cause of abdominal mass. Radiol Case Rep 2019; 15:1-6. [PMID: 31737137 PMCID: PMC6849434 DOI: 10.1016/j.radcr.2019.09.019] [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: 08/23/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 01/08/2023] Open
Abstract
Ewing sarcoma is a malignant tumor that more commonly affects the long bones. Primary Ewing sarcoma of the adrenal gland is a rare diagnosis. We report an unusual case of primary Ewing sarcoma of the adrenal gland in a 34-year-old man who initially presented with abdominal as well as flank pain and abdominal mass. Computed tomography and magnetic resonance imaging showed a heterogeneous, hemorrhagic right adrenal mass with inferior vena cava extension and thrombosis. Thus, a major open surgery including right adrenalectomy, right nephrectomy, inferior vena cava thrombectomy with resection, and a retroperitoneal lymph node dissection was necessitated. Early recognition with radiological imaging and treatment of extraosseous Ewing sarcoma of the adrenal gland with a multimodality approach reduces morbidity and mortality.
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Affiliation(s)
| | - Caleb Tsetse
- Department of Radiology, SUNY Upstate University hospital, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Yesha Sheth
- Department of Pathology, SUNY Upstate University hospital, Syracuse, NY, USA
| | - Ceceleta Maitland
- Department of Radiology, SUNY Upstate University hospital, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Mujtaba Mohammed
- Department of Radiology, SUNY Upstate University hospital, 750 East Adams Street, Syracuse, NY, 13210, USA
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12
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Takigami A, Yamasawa H, Kurosaki A, Sakamoto N, Onuki T, Mato N, Tetsuka K, Endo S, Niki T, Bando M, Hagiwara K. Pazopanib Confers a Progression-free Survival in a Patient with Ewing's Sarcoma/Primitive Neuroectodermal Tumor of the Lung. Intern Med 2019; 58:1335-1339. [PMID: 30626819 PMCID: PMC6543224 DOI: 10.2169/internalmedicine.1549-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ewing's sarcoma (ES)/primitive neuroectodermal tumors (PNETs) are highly malignant neoplasms that usually affect the bones and soft tissues in children and young adults. ES/PNET of the lung is very rare and is associated with a poor prognosis. We herein report a case of ES/PNET of the left lung in a 45-year-old man. He was treated with neoadjuvant chemotherapy and pneumonectomy, but unfortunately his disease recurred 1.5 months after surgery. He was started on pazopanib, which resulted in a five-month progression-free survival. To our knowledge, this is the first demonstration of pazopanib efficacy in ES/PNET of the lung.
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Affiliation(s)
- Ayako Takigami
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Hideaki Yamasawa
- Department of Pulmonary Medicine, International University of Health and Welfare, Japan
| | - Ayako Kurosaki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Noritaka Sakamoto
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Tsugitoshi Onuki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Naoko Mato
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Japan
| | - Toshiro Niki
- Department of Integrative Pathology, Jichi Medical University, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
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13
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Gao J, Chow E, Aloma A, Gupta P. Peripheral primitive neuroendocrine tumor of the chest wall-A case report with pathological correlation. Radiol Case Rep 2018; 13:392-396. [PMID: 29904480 PMCID: PMC6000041 DOI: 10.1016/j.radcr.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/04/2018] [Indexed: 12/20/2022] Open
Abstract
Primitive neuroectodermal tumor is a high-grade malignant tumor originating from the neural crest and neuroectoderm, which can be subdivided into central and peripheral categories. Peripheral primitive neuroectodermal tumor is thought to be identical to Ewing's sarcoma, and falls under a broader category of Ewing's sarcoma family of tumors. Very rarely, it may present without osseous involvement, known as extraosseous Ewing's sarcoma. Here we present a case of a 38-year-old woman, who presented with several-month history of a slow-growing chest wall mass, initially thought to be a breast mass. The mass was diagnosed as extraosseous Ewing's sarcoma upon tissue biopsy. The patient was started on a dose-intensified neoadjuvant therapy, based on protocol from pediatric population given rarity of this tumor in the adult population. While the patient was initially planned for surgical resection, the tumor showed excellent response to chemotherapy on follow-up imaging, and radiation therapy was elected in lieu of resection.
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Affiliation(s)
- Jidi Gao
- Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
- Corresponding author.
| | - Erika Chow
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Aishatu Aloma
- Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Payal Gupta
- Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
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14
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Sobh E, El-Sheshtawy WH, Anis SE. Primary pulmonary extraskeletal Ewing sarcoma/Primitive neuroectodermal tumor: Two case reports. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_48_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Narayan R, Sreedevi J, Rana F, Mishra M, Mohanty R. Primary Pulmonary Primitive Neuro-Ectodermal Tumour (PNET) in an Eight-Year-Old Girl - A Rare Case. J Clin Diagn Res 2016; 10:ED01-ED02. [PMID: 28050377 DOI: 10.7860/jcdr/2016/19709.8839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
Primitive Neuro-Ectodermal-Tumours (PNET) and Ewing's sarcoma are part of the spectrum of Ewing's Family of Tumours (EFT) and show varying degrees of neuroectodermal differentiation. Both these tumours share similar histological and genetic features. PNETs arising primarily in the lungs without pleural or chest wall involvement are extremely rare. We report a case of pulmonary PNET in an eight-year-old girl. To the best of our knowledge, this is the youngest case of primary pulmonary PNET to be reported in paediatric age group in the Indian literature.
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Affiliation(s)
- Radhika Narayan
- Specialist, Department of Pathology, Tata Main Hospital , Jamshedpur, Jharkhand, India
| | - J Sreedevi
- Senior Registrar, Department of Pathology, Tata Main Hospital , Jamshedpur, Jharkhand, India
| | - Farah Rana
- Associate Specialist, Department of Pathology, Tata Main Hospital , Jamshedpur, Jharkhand, India
| | - Minakshi Mishra
- Senior Specialist and HOD, Department of Pathology, Tata Main Hospital , Jamshedpur, Jharkhand, India
| | - Rajesh Mohanty
- Specialist, Department of Pathology, Tata Main Hospital , Jamshedpur, Jharkhand, India
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16
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Mehra S, Atwal SS, Garga UC. Primary Pulmonary Ewing's Sarcoma: Rare Cause of Superior Vena Cava Syndrome in Children. J Clin Diagn Res 2014; 8:RD05-6. [PMID: 25302247 DOI: 10.7860/jcdr/2014/8681.4713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/29/2014] [Indexed: 11/24/2022]
Abstract
Ewing's sarcoma is a common malignant bone tumour presenting in children and young adults. Rarely extra- skeletal soft tissues and visceral organs can also be the site of origin of Ewing's sarcoma. Primary pulmonary Ewing's sarcoma is an extremely rare malignancy which occurs in the paediatric population. We report an unusual case of primary pulmonary Ewing's sarcoma in a nine year old girl who presented with features of superior vena cava syndrome in the emergency department. The diagnosis was confirmed pathologically both by light microscopy and immunohistochemistry. The patient was put on chemotherapy and surgery was planned but the patient expired within three days of starting chemotherapy.
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Affiliation(s)
- Shibani Mehra
- Associate Professor, Department of Radiology, Dr. Ram Manohar Lohia Hospital and PGIMER , New Delhi, India
| | - Swapndeep Singh Atwal
- Senior Resident, Department of Radiology, Dr. Ram Manohar Lohia Hospital and PGIMER , New Delhi, India
| | - Umesh Chandra Garga
- Professor and Head of Department, Department of Radiology, Dr. Ram Manohar Lohia Hospital and PGIMER , New Delhi, India
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