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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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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El Housheimi A, Khalil A, Khalifeh D, Berjawi G, Seoud M, Tabbarah A, Khaled C, Mahfouz R, Abdallah R. Primary vulvar Ewing sarcoma/peripheral primitive neuroectodermal tumor with pelvic lymph nodes metastasis: A case report and review of literature. J Obstet Gynaecol Res 2020; 46:2185-2192. [PMID: 32761741 DOI: 10.1111/jog.14399] [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: 10/08/2019] [Revised: 03/29/2020] [Accepted: 06/28/2020] [Indexed: 11/28/2022]
Abstract
Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumors (pPNET) are soft tissue tumors that generally affect the bones. Extraosseous ES/pPNET has been rarely reported. Our patient presented with a 6 × 4 cm right subcutaneous solid vulvar lesion causing pain and discomfort. Pathology and immunohistochemistry staining showed strong positivity for CD99 and vimentin, favoring the diagnosis of ES/pPNET. Magnetic resonance imaging showed a 6-cm lesion in the right vulvar region with enlarged bilateral inguinal and right iliac lymph nodes. Fluorescence in situ hybridization test for translocation t(11;22)(q24;q12) was positive, confirming the diagnosis. The patient received three cycles of neoadjuvant chemotherapy with vincristine, adriamycin, cyclophosphamide alternating with ifosfamide and etoposide with complete response. The patient underwent vulvar radical local excision. Residual tumor measured 1.6 cm with free margins. She received four additional cycles of adjuvant chemotherapy and 30 sessions radiotherapy. She is currently disease free after 37 months. No ES/pPNET cases with pelvic lymph nodes metastasis were ever reported.
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Affiliation(s)
- Alaa El Housheimi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dalia Khalifeh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghina Berjawi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abir Tabbarah
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Chirine Khaled
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Abdallah
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Cash T, McIlvaine E, Krailo MD, Lessnick SL, Lawlor ER, Laack N, Sorger J, Marina N, Grier HE, Granowetter L, Womer RB, DuBois SG. Comparison of clinical features and outcomes in patients with extraskeletal versus skeletal localized Ewing sarcoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2016; 63:1771-9. [PMID: 27297500 PMCID: PMC4995129 DOI: 10.1002/pbc.26096] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 02/14/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The prognostic significance of having extraskeletal (EES) versus skeletal Ewing sarcoma (ES) in the setting of modern chemotherapy protocols is unknown. The purpose of this study was to compare the clinical characteristics, biologic features, and outcomes for patients with EES and skeletal ES. METHODS Patients had localized ES and were treated on two consecutive protocols using five-drug chemotherapy (INT-0154 and AEWS0031). Patients were analyzed based on having an extraskeletal (n = 213) or skeletal (n = 826) site of tumor origin. Event-free survival (EFS) was estimated using the Kaplan-Meier method, compared using the log-rank test, and modeled using Cox multivariate regression. RESULTS Patients with extraskeletal ES (EES) were more likely to have axial tumors (72% vs. 55%; P < 0.001), less likely to have tumors >8 cm (9% vs. 17%; P < 0.01), and less likely to be white (81% vs. 87%; P < 0.001) compared to patients with skeletal ES. There was no difference in key genomic features (type of EWSR1 translocation, TP53 mutation, CDKN2A mutation/loss) between groups. After controlling for age, race, and primary site, EES was associated with superior EFS (hazard ratio = 0.69; 95% confidence interval: 0.50-0.95; P = 0.02). Among patients with EES, age ≥18, nonwhite race, and elevated baseline erythrocyte sedimentation rate were independently associated with inferior EFS. CONCLUSION Clinical characteristics, but not key tumor genomic features, differ between EES and skeletal ES. Extraskeletal origin is a favorable prognostic factor, independent of age, race, and primary site.
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Affiliation(s)
- Thomas Cash
- Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Health Sciences Research Building, Brumley Bridge, 3 Floor, W-350, 1760 Haygood Drive, Atlanta, GA 30322
| | - Elizabeth McIlvaine
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto Street, SSB 210C, MC 9234, Los Angeles, CA 90032
| | - Mark D. Krailo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto Street, SSB 210C, MC 9234, Los Angeles, CA 90032
| | - Stephen L. Lessnick
- Center for Childhood Cancer and Blood Disorders at Nationwide Children’s Hospital and the Division of Hematology, Oncology and BMT at The Ohio State University, 700 Children’s Drive, WA5011, Columbus, OH 43205
| | - Elizabeth R. Lawlor
- Department of Pediatrics, University of Michigan, D4204 Med Prof Building Box 5718, 1500 East Med Center Drive, Ann Arbor, MI 48109-5718
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Joel Sorger
- Department of Orthopedics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 2017, Cincinnati, OH 45229
| | - Neyssa Marina
- Department of Pediatrics, Stanford University School of Medicine and Lucille Packard Children’s Hospital at Stanford, 1000 Welch Rd., Suite 300, Mail Code 5798, Palo Alto, CA 94304-1812
| | - Holcombe E. Grier
- Department of Pediatrics, Children’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, 44 Binney Street, Boston, MA 02115
| | - Linda Granowetter
- Department of Pediatrics, NYU School of Medicine and NYU Langone Medical Center, 160 East 32nd Street, 2nd Floor, New York, NY 10016
| | - Richard B. Womer
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, 324 South 34th St, Philadelphia, PA 19104
| | - Steven G. DuBois
- Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children’s Hospital, 550 16th Street, 4th Floor, San Francisco, CA 94158
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Takenaka S, Naka N, Obata H, Joyama S, Hamada KI, Imura Y, Kakunaga S, Aoki Y, Ueda T, Araki N, Yoshikawa H. Treatment outcomes of Japanese patients with Ewing sarcoma: differences between skeletal and extraskeletal Ewing sarcoma. Jpn J Clin Oncol 2016; 46:522-8. [PMID: 27008849 DOI: 10.1093/jjco/hyw032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/26/2015] [Accepted: 02/16/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The incidence of Ewing sarcoma is lower in non-Caucasian populations, compared with Caucasian populations, for unknown reasons. Most studies from western countries have reported improvement in outcomes following multi-agent chemotherapy, with no difference in outcome between skeletal and extraskeletal Ewing sarcoma. However, there are few studies of Ewing sarcoma in non-Caucasian populations, with especially few comparing outcomes between skeletal and extraskeletal Ewing sarcoma. Thus, the purpose of this study is to determine whether the outcomes and prognostic factors of Ewing sarcoma in the Japanese population are similar to those in Caucasian populations and to determine whether skeletal and extraskeletal Ewing sarcoma have similar outcomes in Japanese patients. METHODS We retrospectively evaluated the outcomes of 74 Japanese patients with Ewing sarcoma treated between 1981 and 2011 from the Osaka University Orthopaedic Oncology Group. RESULTS Extraskeletal Ewing sarcoma, tumors in the extremities, localized disease at presentation and diagnosis after 2000 were significantly associated with a favorable outcome. Among patients with localized disease at presentation, a significantly better outcome was observed for those with extraskeletal Ewing sarcoma, those who underwent a VDC/IE based or VAIA chemotherapy protocol, and those who were diagnosed after 2000. In the multivariable analyses, extraskeletal Ewing sarcoma was an independent predictor of increased overall survival among all patients and the subset of patients with localized disease. CONCLUSIONS The outcome of patients with Ewing sarcoma in Japan has improved in the last decade. The outcomes and prognostic factors are similar for Japanese and Caucasian patients, though in this series of Japanese patients, a better prognosis was observed for patients with extraskeletal rather than skeletal Ewing sarcoma.
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Affiliation(s)
- Satoshi Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Hideto Obata
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka Department of Orthopaedic Surgery, Yukoukai General Hospital, Osaka
| | - Susumu Joyama
- Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Department of Orthopaedic Surgery, Kawachi General Hospital, Osaka
| | - Ken-Ichiro Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Yoshinori Imura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Shigeki Kakunaga
- Department of Orthopaedic Surgery, Osaka National Hospital, Osaka
| | - Yasuaki Aoki
- Department of Orthopaedic Surgery, Himeji Red Cross Hospital, Hyogo, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, Osaka National Hospital, Osaka
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka
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