Intra-abdominal desmoplastic small round cell tumor (IDSRT)

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 tumour of the pancreas with breast metastasis]

Desmoplastic small round cell tumour (DSRCT) is a very rare, highly aggressive neoplasm. Most cases have been reported in adolescent and young male patients. These tumours occur mainly in the peritoneal cavity, with peritoneal and lymphatic dissemination. Their histologic features are unspecific and immunohistochemistry and cytogenetic or biomolecular techniques are required for their diagnosis. Involvement of the pancreas is exceptional and is difficult to differentiate from other pancreatic primary tumours. We report here the case of a 49-year-old woman who had a DSRCT of the pancreas with metastasis to the breast. She died within one year after the diagnosis despite an aggressive surgical strategy.

Intra-abdominal desmoplastic small round cell tumor: an analysis of 4 cases

AIM: To investigate the clinical features of intra-abdominal desmoplastic small round cell tumor (IDSRCT).

METHODS: We retrospectively analyzed 4 cases of IDSRCT in our hospital from June 1996 to October 2006.

RESULTS: All the 4 cases were admitted with symptoms of ascites and/or abdominal mass. The patients underwent exploratory laparotomy, revealing multiple peritoneal and mesenteric masses with an extensive seeding. The diagnosis was made by pathology after operation.

CONCLUSION: IDSRCT is a very rare peritoneal malignant neoplasm, and it is a disease with high metastasis and poor prognosis.

Combined resection and multi-agent adjuvant chemotherapy for desmoplastic small round cell tumor arising in the abdominal cavity: Report of a case

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive malignancy with distinctive histological features: a nesting pattern of cellular growth within dense desmoplastic stroma, occurring in young population with male predominance. The mean survival period is only about 1.5-2.5 years. The tumor has co-expressed epithelial, muscle, and neural markers in immunohistochemical studies. This work reports a 27-year-old man presenting with hematemesis and chronic constipation. Serial studies including endoscopy, upper gastrointestinal series, abdominal computed tomography and barium enema study showed disseminated involvement of visceral organs. The patient underwent aggressive surgery and received postoperative adjuvant chemotherapy consisting of 5-fluorouracil, cyclophosphamide, etoposide, doxorubicin, and cisplatin. He survived without any disease for 20 mo after the surgery. No standard treatment protocol has been established. Aggressive surgery combined with postoperative multi-agent adjuvant chemotherapy is justified not only to relieve symptoms but also to try to improve the outcome in this advanced DSRCT young patient.

Desmoplastic small round cell tumor: imaging findings associated with clinicopathologic features

PURPOSE

To describe imaging findings of desmoplastic small round cell tumor (DSCRT) and to clarify the relation between radiologic appearances and clinicopathologic features.

MATERIALS AND METHODS

CT scans and MRI examinations of four male patients with histologically confirmed DSCRT (mean age = 20 years) were retrospectively analyzed.

RESULTS

The common imaging finding was multiple peritoneal masses with regular contour situated within mesentery. Tumors showed central low attenuation in 75% of patients on nonenhanced CT. All tumors showed inhomogeneous enhancement on CT. Small foci of punctate calcification were identified in a part of the tumor in all patients. Bone metastases were identified on enhanced CT in two patients 2 and 8 months after diagnosis, respectively. Pleural dissemination was identified in all patients, and one patient had double-sided dissemination. T2-weighted MRI showed inhomogeneous high signal intensity, and small cysts were identified in two patients. Fluid-fluid levels were identified in six tumors on T2-weighted images, which suggested the presence of hemorrhage. Tumors had inhomogeneous signal intensity low or isointense relative to skeletal muscle on T1-weighted images. Two lesions exhibited inhomogeneous enhancement with central low intensity consistent with necrosis.

CONCLUSION

Imaging studies can depict disseminated characteristics and disease extent during the clinical course of DSRCT.