Desmoplastic small round cell tumor in transverse colon: report of a rare case

Multiple Desmoplastic Small Round Cell Tumor in the Intestine: A Case Report

INTRODUCTION

Desmoplastic small round cell tumor (DSRCT) is a highly malignant sarcoma and an extremely rare tumor, predominantly found in the abdominal and pelvic regions. Here, we report the case of a patient who underwent surgical treatment for multiple desmoplastic round cell tumor in the intestine.

CASE PRESENTATION

A 38-year-old male patient visited our hospital after a health check revealed positive occult blood in his stool and a colonoscopy revealed tumors in descending colon and sigmoid colon. Biopsy results revealed poorly differentiated adenocarcinoma. Chest and abdominal enhanced computed tomography revealed 3 tumors from descending colon to sigmoid colon and numerous peritoneal disseminations. Based on these findings, we diagnosed multiple colon cancers and performed a laparoscopic left hemicolectomy. Hematoxylin-Eosin (H&E) staining showed that in all tumors, atypical cells with large and small swollen nuclei formed irregular solid nests of various sizes against a background of extensive desmoplastic or myxomatous stroma. Immunohistochemistry showed that tumor cells were AE1/3 (+), S-100 (-), Desmin (-), WT1 (-). Genetic analysis detected the Ewing's sarcoma and Wilms tumor fusion gene at another inspection agency. Histopathological examination identified desmoplastic small round cell tumor. The patient was discharged on the 19th postoperative day without postoperative complications. He will undergo chemotherapy at another hospital.

CONCLUSIONS

We experienced a very rare case of DSRCT. DSRCT is a fatal disease that primarily affects adolescent and young adult males. Currently, there is no proven treatment. More case reports are essential to improve management of this disease.

Desmoplastic Small Round Cell Tumors of the Gastrointestinal Tract

Desmoplastic small round cell tumors (DSRCTs) of the gastrointestinal (GI) tract are a rare and highly aggressive variant of soft tissue sarcomas, predominantly affecting the abdominal region. These tumors are believed to originate from multipotent mesenchymal stem cells or primitive progenitor cells. They are composed of small round tumor cells associated with prominent stromal desmoplasia, polyphenotypic differentiation, and EWSR1::WT1 gene fusion. Diagnostically, DSRCTs present a significant challenge due to their histological resemblance to other small round cell tumors, such as Ewing sarcoma and rhabdomyosarcoma, necessitating the use of ancillary tests, including immunopanels and molecular analysis, to reach a definitive diagnosis. Immunohistochemical staining, including markers like cytokeratin, vimentin, desmin, and WT1, has proven valuable in differentiating DSRCTs from their mimickers. The prognosis of these tumors is highly dependent on factors such as tumor location and stage at diagnosis, and given their aggressive nature, a multidisciplinary approach may be required that combines surgical resection, chemotherapy, and radiation therapy, among other options. In this review, we provide a synopsis of the pathophysiology of DSRCTs and the latest diagnostic advancements, including the utility of molecular profiling and novel biomarkers.

Role and Efficacy of 18F-FDG PET/CT in Following Up Desmoplastic Small Round Cell Tumor of the Abdomen: A Case Report

Desmoplastic small round cell tumor (DSRCT) is an exceptionally rare and highly aggressive primary peritoneal neoplasm predominantly seen in adolescents and young adults. Despite the availability of various treatment modalities, the prognosis remains grim due to the tumor's aggressive nature and tendency for widespread metastasis. Although imaging of DSRCT is frequently documented using computed tomography (CT), the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the initial diagnosis, staging, and particularly in the follow-up evaluation, is less explored. This case report details the role and efficacy of 18F-FDG PET/CT in the follow-up of a patient with extensive peritoneal involvement by DSRCT, demonstrating its added advantage in monitoring treatment response over conventional CT imaging.

Successful surgical treatment of desmoplastic small round cell tumor in a postmenopausal woman: A rare case report

INTRODUCTION AND IMPORTANCE

Desmoplastic small round cell tumor (DSRCT) is a type of soft tissue sarcoma that arises from mesenchymal cells and primarily affects young males.

CASE PRESENTATION

We present a case of a 58-year-old multiparous woman who presented with colic abdominal pain in the epigastric area and hypogastric area, along with dyspeptic complaints, nausea, constipation every 2-3 days, and a gradual increase of the size of the abdomen.

CLINICAL DISCUSSION

DSRCT is an uncommon and extremely aggressive tumor that occurs in the abdomen. It is typically associated with a grim prognosis and primarily affects young males aged 20 to 30. In our case, the patient underwent a surgical procedure to remove the entire tumor, without the need for chemotherapy or radiotherapy. This decision was made considering the absence of metastasis and cancerous cells in the ascites and the potential adverse effects of these treatments. Throughout a 12-month follow-up period, the patient's health condition improved, as indicated by weight gain.

CONCLUSION

This case report highlights the importance of considering DSRCT in the differential diagnosis of abdominal masses in postmenopausal women and emphasizes the potential for successful treatment through surgical intervention.

Biliary hemorrhage caused by a malignant small round cell tumor in the common bile duct: A case report

BACKGROUND

Malignant small round cell tumor (MSRCT) metastasis to the common bile duct associated with recurrent biliary hemorrhage is extremely rare. Thus far, there have been no reports of metastatic small round cell tumors of the common bile duct.

CASE SUMMARY

Herein, we report the case of a 77-year-old female patient with an MSRCT in the common bile duct. The patient was admitted to hospital due to gastrointestinal hemorrhage and abdominal pain. We found a neoplasm in the common bile duct with active bleeding through a spyglass. We performed biopsy through the spyglass and placed a metal stent to stop bleeding. The pathological result suggested that it was an MSRCT metastasized from the back to the common bile duct. Later, we found using fluorescence in situ hybridization that the SS18 gene break test was negative, ruling out the diagnosis of synovial sarcoma.

CONCLUSION

MSRCT is a group of tumors with similar cell morphology and diffuse histological structure. Complete tumor resection results in improved survival in patients with MSRCT. Roux-en-Y cholangiojejunostomy was performed. After excision of the common bile duct tumor, the patient felt that the abdominal pain improved and hemorrhage disappeared. The patient underwent routine fecal examination one month after surgery, indicating a negative fecal occult blood test. On May 22, 2023, the patient was reexamined by abdominal computed tomography, and no abdominal space occupying lesions or abdominal lymphadenopathy was found.

Highlighting the Diversity of Desmoplastic Small Round Cell Tumor: A Case Series

Desmoplastic small round cell tumor (DSRCT) is a rare malignant tumor that occurs mainly in the retroperitoneum of children and young adults. In its prototypical form, DSCRT displays characteristic morphology with nested primitive small round cells in a desmoplastic stroma and a distinctive immunophenotype with polyphenotypic differentiation. However, DSCRT can also exhibit a broader clinical, histologic and immunohistochemical spectrum and, therefore, cause diagnostic difficulties. Given that DSCRT is an aggressive and nearly universally fatal disease, making the correct diagnosis is critically important. Herein, we report three patients with DSRCT and unusual clinical, morphologic or immunohistochemical characteristics, in order to highlight its remarkable diversity and increase awareness of this unusual, distinctive neoplasm.

Intra-Abdominal Desmoplastic Small Round Cell Tumor: Current Treatment Options and Perspectives

Intra-abdominal desmoplastic small round cell tumor (IDSRCT) is a rare and highly malignant soft tissue neoplasm, which is characterized by rapid progression and poor prognosis. The mechanism underlying the development of this neoplasm remains elusive, but all cases are characterized by the chromosomal translocation t (11;22) (p13; q12), which results in a formation of EWSR1-WT1 gene fusion. The diagnosis of IDSRCT is often made with core-needle tissue biopsy specimens or laparoscopy or laparotomy. Immunohistochemical analyses have shown the co-expression of epithelial, neuronal, myogenic, and mesenchymal differentiation markers. FISH or reverse transcription polymerase chain reaction detecting EWS-WT1 fusion can be performed to assist in molecular confirmation. There is no standard of care for patients with IDSRCT currently, and majority of newly diagnosed patients received the aggressive therapy, which includes >90% resection of surgical debulking, high-dose alkylator-based chemotherapy, and radiotherapy. More recently, targeted therapy has been increasingly administered to recurrent IDSRCT patients and has been associated with improved survival in clinical conditions. Immunotherapy as a possible therapeutic strategy is being explored in patients with IDSRCT. In this review, we summarize currently available knowledge regarding the epidemiology, potential mechanisms, clinical manifestations, diagnosis, treatment, and prognosis of IDSRCT to assist oncologists in comprehensively recognizing and accurately treating this malignancy.

Desmoplastic Small Round Cell Tumor of the Kidney: Report of a Case, Literature Review, and Comprehensive Discussion of the Distinctive Morphologic, Immunohistochemical, and Molecular Features in the Differential Diagnosis of Small Round Cell Tumors Affecting the Kidney

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive neoplasm typically presenting with widespread involvement of the abdominopelvic peritoneum of adolescent males, usually without organ-based primary. Although it is believed to originate from the serous (mainly peritoneal) membranes, intracranial, sinonasal, intraosseous, and other soft tissue sites are also documented. A chromosomal translocation t(11:22)(p13;q12) signature that fuses EWSR1 and WT1 genes results in the production of a chimeric protein with transcriptional regulatory activity that drives oncogenesis. Integration of clinical, morphologic, immunohistochemical, and genetic data is necessary to arrive at the correct diagnosis, especially when the tumor arises in an atypical site. A 15-year-old male presented with hematuria and was found to have a large renal tumor associated with adrenal, liver, lung, and bone metastases. Histopathologic and immunophenotypic features were distinctive for DSRCT. This diagnosis was confirmed by means of fluorescence in situ hybridization and cytogenetic analysis, which documented the pathognomonic t(11;22) translocation, and by reverse transcription polymerase chain reaction on snap-frozen tissue, which revealed the EWSR1/WT1-specific chimeric transcript. Despite high-dose chemotherapy and radiation therapy targeted to a single T11 vertebral metastasis, the disease progressed, and the patient died 4 years after the diagnosis. A search of electronic databases for DSRCT yielded 16 cases of well-documented renal primaries out of around 1570 cases from all sites gathered from the global literature. Desmoplastic small round blue cell tumor and other primary renal tumors considered in the differential diagnosis with DSRCT are discussed.

Subcutaneous desmoplastic small round-cell tumor: An unusual primary location expanding the differential of superficial round-cell tumors

Desmoplastic small round-cell tumor (DSRCT) is a rare, aggressive malignant tumor, which in the great majority of cases arises at abdominal-pelvic sites. Nevertheless, rare cases of primary extra-abdominal tumors have been reported. In challenging cases, its molecular hallmark, the EWSR1-WT1 reciprocal translocation, can be exploited diagnostically by various molecular techniques. Herein, we report an extremely rare case of primary subcutaneous DSRCT in an effort to raise awareness among our dermatopathology colleagues by expanding the differential of superficial round-cell tumors.

Use of anlotinib in intra-abdominal desmoplastic small round cell tumors: a case report and literature review

Background

Intra-abdominal desmoplastic small round cell tumor (IADSRCT) is a highly invasive malignant tumor that is rare in clinical practice. Anlotinib is a multitarget receptor tyrosine kinase inhibitor which inhibits vascular endothelial growth factor receptor (VEGFR) 1-3, fibroblast growth factor receptor (FGFR) 1-4, platelet-derived growth factor receptors (PDGFR) α/β, c-Kit, and Met. In our study, we present a record of IADSRCT which was validly treated by anlotinib.

Case presentation

A 38-year-old man was admitted due to anterior abdominal wall nodule for 1 month. The nodule and intraperitoneal mass were resected and diagnosed IADSRCT. The patient received six cycles of adjuvant chemotherapy and his CT scan revealed metastasis in the right inguinal lymph node and omental lymph node. Anlotinib was then recommended. Anlotinib significantly reduced the lymph nodes after four cycles. The patient continued to use anlotinib as maintenance therapy, and the patient was in good condition. The side effects of anlotinib were high triglycerides and fatigue. However, its toxicity was controllable and tolerable.

Conclusion

This is the first report about anlotinib being effective in the treatment of IADSRCT. This report may provide a new option for the treatment of metastatic IADSRCT.

Effective treatment of apatinib in desmoplastic small round cell tumor: a case report and literature review

BACKGROUND

Desmoplastic small round cell tumor (DSRCT) is a rare malignant sarcoma with poor prognosis due to lack of effective treatments. Apatinib is a new potent oral small-molecule tyrosine kinase inhibitor, and targets the intracellular domain of vascular endothelial growth factor receptor 2 (VEGFR-2). In this study, we presented a case of intra-abdominal DSRCT which was effectively treated by apatinib.

CASE PRESENTATION

A 32-year-old man was admitted due to increasing urination frequency and palpable mass in right lower abdomen for 2 months. The mass was resected and diagnosed DSRCT. The patient refused chemotherapy and radiotherapy,and used Chinese medicine only. Six months after the surgery, the patient re-hospitalized due to growing abdominal mass and ascites. Intraperitoneal cisplatin treatment showed little effect. Apatinib was then recommended. Apatinib revealed outstanding effect on reducing mass size and ascites during 2-month treatment. Apatinib therapy continued for additional 2 months, and the patient was in good condition. The only toxicity was hand-food syndrome, which was controllable and well tolerated.

CONCLUSION

It is the first report that apatinib is effective on DSRCT. This report may provide an additional option for the treatment of metastatic DSRCT.