Extraosseous Ewing sarcoma of the vagina: a rare entity

Ewing Sarcoma of the Vagina: A Rare Clinical Entity

Ewing sarcoma (EwS), a malignancy primarily affecting adolescents and young adults, encompasses various types such as bone, extraskeletal, chest wall, and soft tissue-based tumors, all of which share a common genetic origin. A small portion of them are extraosseous, impacting diverse anatomical sites. Characterized by a specific translocation, this rare cancer rarely involves the vagina, with very few documented cases. This report details the unique case of a middle-aged woman diagnosed with extraosseous vaginal EwS, a rarity in this age group and gender. With no established guidelines, a multidisciplinary approach is crucial, emphasizing the need for further case reporting to enhance understanding and management strategies.

An unusual presentation of extraskeletal vaginal Ewing sarcoma: A case report

Ewing sarcoma (ES) is a rare, aggressive malignancy that typically arises from bone and is seen more in adolescents and young adults. In contrast, extraskeletal Ewing sarcoma (EES) is more prevalent in adults and women [1,2]. There is no standard treatment for extraskeletal tumors, especially those in sensitive areas, such as the vagina, where resection may cause a large cosmetic or functional deformity. This case features a woman in her 20s who presented with painless vaginal bleeding and was found to have a 4 × 5 × 4-mm EES of the posterior vaginal wall. The presentation raised both reproductive and functional concerns, as the patient was young, sexually active and of childbearing age. The patient underwent treatment with radiation therapy and chemotherapy every 3 weeks. Given the lack of guidance and proclivity of EES to metastasize, it is paramount to proceed with standard-of-care treatment even if it is small and there is a lack of metastatic disease. For women with vaginal EES who are of childbearing age, brachytherapy rather than surgical resection may be a more favorable option when considering the location and the potential impact of vaginectomy.

Extraskeletal Ewing sarcoma of thyroid gland: A case report

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.

Importance of studying primitive neuroectodermal tumors and extraosseous Ewings sarcoma of the vagina and vulva

Primitive neuroectodermal tumor (PNT) and Ewing's sarcoma are rare, round-cell tumors, characterized by the presence of the t(11; 22)(q24; q12) chromosomal translocation. A review of the literature revealed only 38 previously reported cases of vulvar PNT and Ewing's sarcoma and 15 vaginal PNT and Ewing's sarcoma. Although rare, these types of tumors should be taken into consideration when making a differential diagnosis for vulvar or vaginal tumors. The currently available data is limited, and therefore, case reports are essential for improving knowledge and management of these types of extremely rare tumors. However, further molecular and histopathological studies are essential for an improved understanding of these conditions and for an early, correct diagnosis. Although the gathered and presented data from the present review are limited, the literature demonstrates that the outcome of these types of cancer are more favorable compared with outcomes observed for carcinomas in more typical locations.

Primary vaginal Ewing sarcoma with uterine fibroid: A case report

RATIONALE

Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported.

PATIENT CONCERNS

The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size.

DIAGNOSIS

Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall.

INTERVENTIONS

The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy.

OUTCOMES

The patient recovered well without local recurrence for >1 year.

LESSONS

Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.

Peripheral primitive neuroendocrine tumor of the chest wall-A case report with pathological correlation

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.

Appearance of extraosseous pelvic Ewing sarcoma on triphasic bone scan

A 24-year-old man with extraosseous Ewing sarcoma in the pelvis underwent a triphasic bone scintigraphy to rule out bone metastases and local bone infiltration before chemotherapy. The bone scintigraphy showed tracer uptake in the tumor in all 3 phases.