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Alsulaiman HM, AlThaqib R, Maktabi AMY, Alkatan HM, Elkhamary SM, Schellini SA. An advanced case of pediatric ciliary body medulloepithelioma with detailed literature review. Int J Surg Case Rep 2024; 115:109242. [PMID: 38245941 PMCID: PMC10830520 DOI: 10.1016/j.ijscr.2024.109242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Medulloepithelioma is the second most common primary intraocular malignant tumor in children but is often diagnosed late, which worsens the prognosis. CASE PRESENTATION We are reporting a 6-year-old boy presenting with a ciliary body (CB) teratoid malignant medulloepithelioma (TMM), which was missed at the initial presentation. We added our case to the 97 previously reported cases in our literature review that were confirmed by cytological or histopathological examination. DISCUSSION Medulloepithelioma has a wide age range at presentation with a mean of 5.3 ± 4.1 years, and slight male predominance (M: F ratio of 1.15). Clinically, the main symptoms/ signs are reduced visual acuity, lens changes, or a pupil "mass." Almost all reported medulloepitheliomas were unilateral (98 %). Histopathologically, non-teratoid malignant medulloepithelioma (NTMM) (35.7 %) and TMM (34.5 %) were the commonest. Enucleation was the main treatment modality because of the large tumor size of 72.7 %. A combination of chemotherapy and/or radiotherapy was used in 15.1 % and brachytherapy for small lesions in 14.1 %. Orbital exenteration was needed in 3 cases because of orbital invasion. CONCLUSION A CB medulloepithelioma tumor can be easily missed, diagnosed late, with less chance for globe salvaging. The malignant types are more common and may result in orbital invasion, requiring even more extensive surgery. Therefore, when facing a child with lens changes, a pupil "mass," or raised intraocular pressure, pediatricians and general ophthalmologists must have an earlier suspicion and be aware of this rare entity to improve outcomes and reduce loss of vision or other disease-related morbidity.
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Affiliation(s)
- Hamad M Alsulaiman
- Oculoplastic department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rawan AlThaqib
- Oculoplastic department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and laboratory Medicine department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology and Pathology departments, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Sahar M Elkhamary
- Radiology department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Diagnostic Radiology department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Egypt
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Gupta K, Sood R, Salunke P, Chatterjee D, Madan R, Ahuja CK, Jain R, Trehan A, Radotra BD. Clinicopathological characteristics and outcomes in embryonal tumor with multilayered rosettes: A decade long experience from a tertiary care centre in North India. Ann Diagn Pathol 2021; 53:151745. [PMID: 33964610 DOI: 10.1016/j.anndiagpath.2021.151745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Embryonal tumor with multilayered rosettes (ETMR) are a heterogenous group clinically, pathologically and topographically. Due to limited cases, data regarding its molecular genetics, pathology and prognostic factors is evolving. We retrospectively analysed our cohort of ETMR over last decade in order to study their clinicopathological characteristics and outcome. METHODS Our cohort consisted of patients diagnosed with Embryonal tumor with abundant neuropil and true rosettes (ETANTR)/Ependymoblastoma (EBL)/ Medulloepithelioma (MEPL) over the past decade. Clinical details, including outcome and imaging data was retrieved. Histological analysis including immunohistochemical work-up was performed. RESULTS Cohort included 15 patients with age range between 1 and 28 years and M:F ratio of 1.5:1. Supratentorial location predominated in comparison to tumors arising in posterior fossa. ETANTR and EBL patterns were equally distributed (40% each), followed by one case each of mixed pattern (EBL + ETANTR), MEPL and embryonal tumor, unclassified. All tumors readily expressed LIN 28A and INI-1 was retained. Recurrence with evidence of glial and rhabdoid differentiation was noted in a single patient 9 months following resection. Follow-up period ranged from 1 to 31 months, with overall median survival of 6.4 months. Eight patients were planned for adjuvant treatment following surgery, of which only four could complete it. All patients, except for one, succumbed to the disease. CONCLUSIONS ETMR have a heterogenous morphology and gathers ETANTR, EBL, MEPL within its spectrum. Following treatment, the recurrent tumor may feature glial/rhabdoid differentiation. LIN28A is expressed in all cases, however should be interpreted in context of histology. Prognosis of ETMR remains dismal despite multimodal therapy.
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Affiliation(s)
- Kirti Gupta
- Departments of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ridhi Sood
- Departments of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Departments of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Departments of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Departments of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Kamal Ahuja
- Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Jain
- Departments of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Departments of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Dass Radotra
- Departments of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Medulloepithelioma is an extremely rare highly malignant and rapidly growing tumor that occurs in the central nervous system. There are few reports of medulloepithelioma located in the ventricle. Medulloepithelioma is common in young children and adolescence. Herein, we described an unusual case of vomiting in a 4-year-old male patient with medulloepithelioma, presenting with enlarging head circumference. Because of computed tomography (CT) scan of the head showed signs of brain tumors and hydrocephalus, and enhanced magnetic resonance imaging (MRI) sequence showed increased heterogeneity and honeycomb-like changes on the mass after the administration of a contrast agent, the patient was first diagnosed as choroid plexus papilloma. After undergoing a surgical craniotomy, the patient was diagnosed as medulloepithelioma through pathological examination. We hope that this work will provide more understanding and knowledge of intracranial medulloepithelioma. For medulloepithelioma that occurs in the central nervous system, radiological examination is not sufficient to make a definite diagnosis of the tumor. Pathological examination can confirm the diagnosis of medulloepithelioma and distinguish it from other central system tumors. Surgical resection is a safe and effective method that can prolong the life of patients. However, the prognosis of medulloepithelioma is still poor, and further research is needed to improve the diagnosis and treatment of this rare disease.
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Affiliation(s)
- Hong You
- Department of Neurosurgery, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Jiangtao Dong
- Department of Neurosurgery, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Jian Xu
- Department of Neurosurgery, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Dong Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Qi Liu
- Department of Neurosurgery, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
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Mendonça GS, Artiles CB, Malheiros GC, Amorim VB. Presacral medulloepithelioma with peritoneal carcinomatosis in an 11-year-old boy: An extremely rare association. Radiol Case Rep 2021; 16:1153-7. [PMID: 33747332 DOI: 10.1016/j.radcr.2020.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 11/22/2022] Open
Abstract
Medulloepithelioma is a rare and highly malignant tumor of infancy and early childhood, and classified as a primitive neuroectodermal tumor. Considering that most cases occur in the central nervous system, development in atypical sites associated with secondary comorbidities, such as peritoneal carcinomatosis, becomes an extremely rare association due to its high morbimortality. This study reports a rare case of peripheral medulloepithelioma with peritoneal carcinomatosis in an 11-year-old boy, with a 4-year history of intestinal constipation alternated with fecal incontinence, taken to the emergency room due to increasing abdominal pain and urinary retention. This report aims to contribute to a better understanding of this rare pathology, as well as assist in the establishment of early diagnosis and treatment.
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Mudhar HS, Milman T, Eagle RC, Sanderson T, Pheasey L, Paine S, Salvi S, Rennie IG, Rundle P, Shields CL, Shields JA. Usefulness of PAX8 Immunohistochemistry in Adult Intraocular Tumor Diagnosis. Ophthalmology 2020; 128:765-778. [PMID: 33002562 DOI: 10.1016/j.ophtha.2020.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the distribution of the PAX8 transcription factor protein in ocular tissues and to investigate if immunohistochemical stains for this biomarker are useful in the diagnosis of intraocular tumors. DESIGN Observational case series. PARTICIPANTS Excision and cytologic analysis specimens of 6 ciliary body epithelial neoplasms, 2 iris epithelial neoplasms, 3 retinal pigment epithelial neoplasms, 3 intraocular medulloepitheliomas, 15 uveal melanomas, and 5 uveal melanocytomas. METHODS Hematoxylin-eosin and PAX8 immunohistochemical stains were performed on all specimens. In appropriate cases, bleached preparations and other immunohistochemical stains, including AE1/AE3 cytokeratin, Lin28A, and CD45, were performed. MAIN OUTCOME MEASURES Distribution of PAX8 expression in normal and neoplastic tissue. RESULTS Strong nuclear PAX8 expression was observed in the normal corneal epithelium, iris sphincter pupillae muscle, iris pigment epithelium and dilator muscle complex, nonpigmented and pigmented epithelia of the ciliary body, lens epithelium, and a subset of retinal neurons. The normal retinal pigment epithelium and uveal melanocytes did not stain for PAX8. The ciliary body epithelial and neuroepithelial tumors (adenoma, adenocarcinoma, and medulloepithelioma) showed uniform strong nuclear PAX8 immunoreactivity. All melanocytic tumors (iris melanoma, ciliary-choroidal melanoma, and melanocytoma) and retinal pigment epithelial neoplasms showed negative results for PAX8. A subset of tumor-associated lymphocytes, most prominent in uveal melanoma, showed positive results for PAX8. The uniformity of the PAX8 staining was superior to the variable cytokeratin staining in the ciliary epithelial neoplasms and the variable Lin28A staining in malignant medulloepithelioma. The veracity of PAX8 staining was equally as robust on cytologic analysis and open-flap biopsy specimens of ciliary epithelial and iris epithelial neoplasms, melanocytoma, and melanoma. CONCLUSIONS PAX8 has proven to be a very useful diagnostic marker in a select group of adult intraocular tumors, and we highly recommend its inclusion in diagnostic antibody panels of morphologically challenging intraocular neoplasms.
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Affiliation(s)
- Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tracy Sanderson
- Immunohistochemistry, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Leanne Pheasey
- Immunohistochemistry, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Simon Paine
- Neuropathology, Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - Sachin Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Ian G Rennie
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Paul Rundle
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Attiku Y, Rishi P, Biswas J, Krishnakumar S. Plaque radiation for ciliary body medulloepithelioma presenting with neovascular glaucoma and vitreous hemorrhage in 13-year-old Asian girl. Am J Ophthalmol Case Rep 2020; 18:100719. [PMID: 32373758 PMCID: PMC7191537 DOI: 10.1016/j.ajoc.2020.100719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yamini Attiku
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, 600006, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, 600006, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Sankara Nethralaya, 18 College Road, Chennai, 600006, Tamilnadu, India
| | - Subramanian Krishnakumar
- L&T Ophthalmic Pathology Department, Sankara Nethralaya, 18 College Road, Chennai, 600006, Tamilnadu, India
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Sarangi J, Kakkar A, Roy D, Thakur R, Singh CA, Sharma MC. Ocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes. Eur J Ophthalmol 2019; 31:NP126-NP130. [PMID: 31411051 DOI: 10.1177/1120672119870079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a rare presentation of a case of intraocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes. CASE DESCRIPTION A 9-year-old male child with previous history of ciliary body non-teratoid medulloepithelioma presented with a swelling in the right pre-auricular region for 1 month. Magnetic resonance imaging and positron emission tomography-computed tomography showed a right intraparotid mass with enlarged ipsilateral cervical lymph nodes. A core biopsy was taken from the lesion, which on microscopy showed a tumor composed of small round cells arranged in cords, tubules lined by multilayered cells, and in cribriform pattern. These cells were embedded in a hypocellular, loose myxoid matrix. Based on the histopathological characteristics and previous history, a diagnosis of medulloepithelioma metastastic to ipsilateral parotid gland was made. The patient underwent right total conservative parotidectomy and bilateral neck dissection. Histopathological examination revealed metastatic medulloepithelioma in five out of eight intraparotid lymph nodes, with extranodal extension into the adjacent parotid parenchyma. Foci of hyaline cartilage were identified within the tumor, leading to a diagnosis of metastatic teratoid medulloepithelioma. CONCLUSION Intraparotid lymph node metastases from intraocular medulloepithelioma is a rare possibility and we recommend that the parotid should be evaluated in cases of intraocular medulloepithelioma at initial presentation as well as during the follow-up period. Also, metastasis should be considered in all pediatric patients with solitary mass lesions showing unconventional histology for a primary parotid neoplasm.
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Affiliation(s)
- Jayati Sarangi
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Diya Roy
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Rishikesh Thakur
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Omari Y, Karkash AA, Mansour RA, Amayiri N, Swaidan M, Al-Hussaini M. Medulloepithelioma with heterologous osteoid component: a case report and review of literature. Childs Nerv Syst 2019; 35:1035-1039. [PMID: 30617578 DOI: 10.1007/s00381-018-04041-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Medulloepithelioma is a rare brain tumor that has been classified as embryonal tumor with multilayered rosettes (ETMR) if it harbors C19MC amplification. In rare instances, it shows evidence of heterologous differentiation. METHODS We report a case of a 10-year-old female who presented with headache, squint, and minimal left sided weakness of 1 week duration. RESULTS Microscopy revealed a small round blue cell tumor with focal glandular and tubular differentiation. In one focus, well-developed osteoid was identified. The tumor labeled with LIN28A immunostain. CONCLUSIONS Unusual features can be encountered in medulloepithelioma which should be in the differential diagnosis of CNS embryonal tumors. Full description of the case with review of the literature and comparison between cases with and without heterologous elements is presented.
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Affiliation(s)
- Yanal Omari
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | | | | | - Nisreen Amayiri
- Department of Pediatrics, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Maisa Swaidan
- Department of Radiology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center (KHCC), 202 Queen Rania Street, P.O. Box 1269 Al-Jubeiha, Amman, 11941, Jordan.
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Jaramillo S, Grosshans DR, Philip N, Varan A, Akyüz C, McAleer MF, Mahajan A, McGovern SL. Radiation for ETMR: Literature review and case series of patients treated with proton therapy. Clin Transl Radiat Oncol 2018; 15:31-37. [PMID: 30582019 PMCID: PMC6297264 DOI: 10.1016/j.ctro.2018.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Embryonal tumors with multilayered rosettes (ETMRs) are aggressive tumors that typically occur in young children. Radiation is often deferred or delayed for these patients due to late effects; proton therapy may mitigate some of these concerns. This study reviews the role of radiation in ETMR and describes initial results with proton therapy. Materials and methods Records of patients with embryonal tumor with abundant neuropil and true rosettes (ETANTR), medulloepithelioma (MEP), and ependymoblastoma (EPL) treated with proton therapy at our institution were retrospectively reviewed. A literature review of cases of CNS ETANTR, MEP, and EPL published since 1990 was also conducted. Results Seven patients were treated with proton therapy. Their median age at diagnosis was 33 months (range 10-57 months) and their median age at radiation start was 42 months (range 17-58 months). Their median overall survival (OS) was 16 months (range 8-64 months), with three patients surviving 36 months or longer. Five patients had disease progression prior to starting radiation; all 5 of these patients failed in the tumor bed. A search of the literature identified 204 cases of ETMR with a median OS of 10 months (range 0.03-161 months). Median OS of 18 long-term survivors (≥36 months) in the literature was 77 months (range 37-184 months). Of these 18 long-term survivors, 17 (94%) received radiotherapy as part of their initial treatment; 14 of them were treated with craniospinal irradiation. Conclusions Outcomes of patients with ETMR treated with proton therapy are encouraging compared to historical results. Further study of this rare tumor is warranted to better define the role of radiotherapy.
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Affiliation(s)
- Sergio Jaramillo
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, United States
| | - David R Grosshans
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy Philip
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Ali Varan
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, Ankara, Turkey
| | - Canan Akyüz
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, Ankara, Turkey
| | - Mary Frances McAleer
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Susan L McGovern
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, United States
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Hellman JB, Harocopos GJ, Lin LK. Successful treatment of metastatic congenital intraocular medulloepithelioma with neoadjuvant chemotherapy, enucleation and superficial parotidectomy. Am J Ophthalmol Case Rep 2018; 11:124-7. [PMID: 30128367 DOI: 10.1016/j.ajoc.2018.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To report a case of metastatic intraocular medulloepithelioma successfully treated with neoadjuvant chemotherapy, superficial parotidectomy, and enucleation. Observations A 5-year-old male with history of cataract surgery, glaucoma drainage device, endocyclophotocoagulation, scleral patch grafting, and chronic posterior "inflammation" in a blind left eye presented with a rapidly enlarging painful mass under the left upper eyelid. Biopsy of the conjunctival mass and fine needle aspiration of an enlarged preauricular lymph node revealed medulloepithelioma, which was also seen in the left parotid gland on positron emission tomography (PET) scan. The patient's father refused exenteration, so the patient received 3 cycles of vincristine, cisplatin, cyclophosphamide, and etoposide per a retinoblastoma protocol. Repeat magnetic resonance imaging (MRI) showed regression of ocular extension, and an enucleation was performed, histologically confirming the diagnosis of malignant, non-teratoid medulloepithelioma. The child later underwent superficial parotidectomy and received an additional round of chemotherapy. There has been no evidence of recurrence for 9 years. Conclusions and importance There is no standard treatment for metastatic intraocular medulloepithelioma. The neoadjuvant chemotherapy regimen used in our patient led to regression of the extrascleral extension of the tumor, allowing for enucleation rather than a more disfiguring exenteration, as well as likely improving his prognosis. We believe that it is reasonable to consider neoadjuvant chemotherapy for patients with extrascleral and/or metastatic medulloepithelioma.
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11
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Oumghar N, Hazmiri FE, El Omrani A, Rais H, Khouchani M. Posterior cerebral fossa medulloepithelioma: report of a case. BMC Clin Pathol 2017; 17:23. [PMID: 29200961 PMCID: PMC5697137 DOI: 10.1186/s12907-017-0064-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background Medulloepithelioma is a rare primitive neuroectodermal tumor of the central nervous system, usually developing in childhood. Due to its rarity, the optimal management is still unknown. The prognosis is poor, especially when resection is incomplete. Adjuvant radiochemotherapy is often indicated. Case presentation We report a rare case of infratentorial medulloepithelioma in a 3 year old girl. She presented symptoms of increased intracranial pressure. On examination, she had coordination problems, ptosis and exotropia of the right eye. Magnetic resonance imaging demonstrated a large cerebellar vermix tumor. Immuno-histochemistry revealed a diffuse positivity for Vimentin and focal positivity for the epithelial membrane antigen, but Glial Fibrillary Acidic Protein and Synaptophysin were negative, the MIB-1 antibody was very high. She received postoperative craniospinal irradiation and died 7 months later. Conclusion We describe the features (epidemiological, clinical, histological, immunohistochemical and therapeutic outcomes) of our case and confront it to literature data.
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Affiliation(s)
- Nezha Oumghar
- Radiotherapy department - Oncology and hematology center, Mohammed VI University Hospital, Marrakech, Morocco
| | - Fatima Ezzahra Hazmiri
- Pathology department - Arrazi Hospital, Mohammed VI University Hospital, Marrakech, Morocco
| | - Abdelhamid El Omrani
- Radiotherapy department - Oncology and hematology center, Mohammed VI University Hospital, Marrakech, Morocco
| | - Hanane Rais
- Pathology department - Arrazi Hospital, Mohammed VI University Hospital, Marrakech, Morocco
| | - Mouna Khouchani
- Radiotherapy department - Oncology and hematology center, Mohammed VI University Hospital, Marrakech, Morocco
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Pushker N, Bajaj MS, Singh AK, Lokdarshi G, Bakhshi S, Kashyap S. Intra-ocular medulloepithelioma as a masquerade for PHPV and Panophthalmitis: a Diagnostic Dilemma. Saudi J Ophthalmol 2017; 31:109-111. [PMID: 28559724 PMCID: PMC5436372 DOI: 10.1016/j.sjopt.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 02/08/2017] [Indexed: 12/02/2022] Open
Abstract
A previously diagnosed child of persistent hyperplastic primary vitreous (PHPV) with painless blind eye remained clinically silent for about 3 years follow-up. The child suddenly presented as a case of orbital cellulitis and panopthalmitis with meningitis. No definite mass lesion was detected on ultrasonography, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan. Histopathology of the enucleated eye revealed intra-ocular medulloepithelioma as the culprit of sterile panophthalmitis and orbital inflammation.
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Affiliation(s)
- Neelam Pushker
- Oculoplastic and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Mandeep S Bajaj
- Oculoplastic and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ashutosh K Singh
- Oculoplastic and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Gautam Lokdarshi
- Oculoplastic and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sameer Bakhshi
- Paediatric Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Seema Kashyap
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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13
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Abstract
Second cancers in survivors of hereditary retinoblastoma occur much more commonly than in the general population. This can be attributed both to the germline mutation of the RB gene and chemoradiation used for treatment of this paediatric cancer. Medulloepithelioma is an uncommon tumor of neuroectodermal origin, seen largely in the paediatric population and rarely reported in adults. Though the incidence of second malignancies is common in retinoblastoma, medulloepithelioma as a second malignancy in retinoblastoma survivors is rare, with only one case reported so far. Herein, we present a case of a 29-year-old patient presenting with medulloepithelioma of the right orbit, arising in the radiation field of previously treated retinoblastoma. This case was also peculiar in that though the origin of tumor was in the eyeball it had a very aggressive clinical course.
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Affiliation(s)
| | - Rony Benson
- a Department of Radiation Oncology , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Kashyap
- b Department of Ocular Pathology , All India Institute of Medical Sciences , New Delhi , India
| | - K P Haresh
- a Department of Radiation Oncology , All India Institute of Medical Sciences , New Delhi , India
| | - Subhash Gupta
- a Department of Radiation Oncology , All India Institute of Medical Sciences , New Delhi , India
| | - Dayanand Sharma
- a Department of Radiation Oncology , All India Institute of Medical Sciences , New Delhi , India
| | - Goura Kishor Rath
- a Department of Radiation Oncology , All India Institute of Medical Sciences , New Delhi , India
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14
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Abstract
Medulloepithelioma is a rare congenital tumor of the ciliary body and iris. The current classification and grading of medulloepithelioma shows inconsistencies and does not reflect clinical behavior. This position paper discusses the backgrounds of the current classification and intends to initiate a discussion on an alternative classification and grading scheme.
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Affiliation(s)
- Robert M Verdijk
- Section of Ophthalmic Pathology, Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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