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A Rare Case of Gastric Metastasis in Ewing’s Sarcoma of the Femur

A Rare Case of Gastric Metastasis in Ewing’s Sarcoma of the Femur Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 2870302, 4 pages https://doi.org/10.1155/2019/2870302 Case Report 1 1 1 Krishna Amulya Koti , Selvamani Backianathan , Patricia Sebastian , 2 3 4 Leni G. Matthew, Mithun Raam, and Dipti Masih Department of Radiation Oncology, Christian Medical College, Vellore, India Department of Child Health, Christian Medical College, Vellore, India Department of General Surgery, Christian Medical College, Vellore, India Department of Pathology, Christian Medical College, Vellore, India Correspondence should be addressed to Patricia Sebastian; patricia.solomon@gmail.com Received 6 February 2019; Accepted 7 May 2019; Published 14 May 2019 Academic Editor: Raffaele Palmirotta Copyright © 2019 Krishna Amulya Koti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The stomach is a very unusual site of metastasis. Published reports on metastatic lesion in the stomach is generally limited to single case reports and case series. Gastric metastasis in an Ewing’s sarcoma is extremely rare and has been reported in English literature but once to our knowledge. We present a case report of Ewing’s sarcoma of the right proximal femur metastasizing to the stomach. A young female treated for Ewing’s sarcoma of the femur in 2012 presented with gastric metastasis after four years of disease-free interval. She was treated with irinotecan-based chemotherapy followed by total gastrectomy with esophagojejunal anastomosis and radiation therapy. At one-year follow-up, she was disease free. 1. Background resonance imaging (MRI) showed right proximal femur lesion. Biopsy from the same was reported as malignant small Ewing’s sarcoma family of tumours (EFTs) comprises of a round cell tumour suggestive of Ewing’s sarcoma. Tumour spectrum of tumours with a common histological, immuno- cells were immunopositive for CD99 and negative for CD3, histochemical, and chromosomal translocations. It includes CD79a, MPO, and desmin. There was no systemic metastasis Ewing’s sarcoma, extra-skeletal Ewing’s sarcoma, Askin’s on further evaluation. She received 6 cycles of chemotherapy tumour, and peripheral primitive neuroectodermal tumour with vincristine, ifosfamide, doxorubicin, and etoposide [1]. One of the major prognostic factors for survival is the (VIDE) followed by a wide local excision of the tumour with presence of metastasis. The lung and other bones are com- endoprosthesis insertion on 06/09/2012. Surgical specimen mon sites of metastasis; other sites being unusual and rare. histopathology examination did not show viable tumour. The stomach is an uncommon site for primary Ewing’s sar- Margins were free of tumour. She had received further 8 coma; it is a very rare site for metastasis [2]. We report a case cycles of vincristine, ifosfamide, and actinomycin D (VAI). of stomach metastasis in a patient treated for Ewing’s sar- She was on regular follow-up. In 2016, she had presented coma of the extremity. To our knowledge, only one case with abdominal pain with low-grade fever and unquantified has been reported in literature of Ewing’s sarcoma with stom- weight loss. Ultrasound abdomen showed epigastric mass ach metastasis so far. measuring 8cm × 7 5cm. 2.1. Investigation. On computed tomography (CT) of the 2. Case Presentation abdomen and pelvis (Figure 1), a 9 cm × 11 cm × 10 cm (ante- A 14-year-old girl presented to our hospital in February 2012 roposterior×craniocaudal×transverse) well-defined exophytic with complaints of painful swelling of the right thigh for 8 mixed solid-cystic mass was located along the lesser curvature months and difficulty in walking. There was no history of of the stomach bulging into the superior and inferior recesses trauma, fever, or other constitutional symptoms. Magnetic of the lesser sac. The lesion had thick, irregular walls and 2 Case Reports in Oncological Medicine Figure 2: Gastroscopy showing mucosal bulge along the lesser curvature. Figure 1: CT coronal section of the abdomen and pelvis showing a well-defined solid-cystic mass along lesser curvature of the stomach. enhancing solid components interspersed within. Multiple enhancing intratumoral vessels were present. Mass was seen abutting the inferior surface of the left lobe of the liver superi- orly, the pancreatic body posteroinferiorly with no definite invasion. There was no loss of fat plane with adjacent struc- tures. No lymphadenopathy or ascites was noted. Upper gastrointestinal endoscopy showed a mucosal Figure 3: Surgical specimen shows the stomach with tumour. bulge along the lesser curvature of the body of the stomach and proximal antrum (Figure 2). A single deep mucosal ulcer was noted in the mid-body along the lesser curvature with 80-85%), consistent with Ewing’s sarcoma. Hematoxylin surrounding mucosal edema and erythema and friability. and eosin staining showed characteristic uniform cells with Clinical differentials considered were gastrointestinal stromal the round nuclei, small nucleoli with scant-to-moderate clear tumour (GIST), lymphoma, and adenocarcinoma. Metastasis cytoplasm (Figures 4(a) and 4(b)). Margins were free of was considered unlikely in view of the stomach being a rare tumour. Omentum was noted to have focal tumour deposit. site. However, biopsy from the lesion was reported as malig- Eight perigastric lymph nodes with reactive hyperplasia. On nant round cell tumour, immunopositive for CD99 and FLI- immunohistochemistry, the tumour cells were diffusely pos- 1. Immunohistochemistry marker for CK, DOG, desmin, and itive for CD99 (Figure 4(c)). In view of poor response to che- TdT was negative ruling out epithelial tumours, GIST, rhab- motherapy, following discussion with the multidisciplinary domyosarcoma, and lymphoblastic lymphomas, respectively. tumour board, it was decided to rule out anaplastic large- Bone marrow examination did not reveal metastatic infiltra- cell lymphoma. Pathologist had a re-look at her biopsy and tion. No suspicious lesions were seen on bone scintigraphy. surgical specimen slides. Lymphoma and GIST IHC panel was negative. FLI-1 was positive on immunohistochemistry CT thorax was negative for lung metastasis. (Figure 4(d)). Reverse transcription polymerase chain reac- 2.2. Treatment. After discussion with the multidisciplinary tion (RT-PCR) on the gastric resection specimen was nega- tumour board (MDT), it was considered to be a metastatic tive for EWS-FLI-1 types 1 and 2, EWS-ERG, and EWS- lesion from previous Ewing sarcoma and it was planned to FEV translocations. After ruling out epithelial tumours, rhabdomyosarcoma, lymphoma, and GIST, the likelihood offer her systemic chemotherapy followed by assessment for gastrectomy. She received 6 cycles of chemotherapy with iri- of having a RT-PCR negative Ewing’s sarcoma that is known notecan and temozolomide till 07/03/17. to have an incidence of 10-15% was considered. She underwent total gastrectomy with end-to-side esopha- It was decided to offer her radiation therapy in view of gojejunal stapled anastomosis and feeding jejunostomy on poor response to chemotherapy and omental deposit by the MDT team. A renogram was performed prior to initiation 07/04/17 (surgical specimen is seen in Figure 3). At surgery, an exophytic lesion along the lesser curvature of the stomach of RT, and an informed consent was obtained. She received with mucosal involvement adherent to the transverse mesoco- intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 lon was found. There was no ascites or liver or nodal metastasis. fractions, delivered once a day over 5 and a half weeks. She Surgical specimen histopathological examination was received further chemotherapy with irinotecan and temozo- lomide till July 2017. reported as malignant round cell tumour (viable tumour: Case Reports in Oncological Medicine 3 (a) (b) (c) (d) Figure 4: Histopathological images. (a) Hematoxylin and eosin (H&E) 200x magnification. Photomicrograph shows diffuse sheets of tumour cells. (b) H&E 400x uniform cells with round nuclei; small nucleoli with scant-to-moderate clear cytoplasm. (c) Immunohistochemistry (IHC) staining for CD99 shows crisp cytoplasmic membrane staining. (d) IHC for FLI-1 shows moderate nuclear staining in the tumour cells. radiation), the 5-year survival rates for nonmetastatic disease At the last follow-up in March 2018, the patient was doing well without evidence of the disease. ranges from 50 to 70% [6]. Incidence of metastasis is reported to be 20-30%, and the 5-year survival rate has improved from 20% to 30-40% with effective multidrug chemotherapy regi- 3. Discussion mens in metastatic disease [7]. The lung and bones are the Ewing’s sarcoma was first described as diffuse endotheli- most common sites of metastasis. Patients with isolated oma of the bone by James Ewing in 1921. It is the second metastasis to the lung were found to have better prognosis over patients with nonpulmonary metastatic sites [8]. most common primary bone malignancy in children and adolescents [3]. Long bones are the usual sites of presenta- We report a case of Ewing’s sarcoma with stomach metastasis. Gastric metastasis is very rare and was reported tion in Ewing’s sarcoma with the femur being the most common. Ewing’s sarcoma and peripheral primitive neu- in very few breast malignancies and malignant melanomas roectodermal tumours were considered different entities [9, 10]. Few case reports of primary extraosseous Ewing’s sar- coma of the stomach were described [11]. However, there is in the past. However, recent cytogenetic and molecular studies suggest that they indeed are two ends of the same extreme paucity of literature on the stomach being a metasta- tic site for Ewing’s sarcoma. To our knowledge, only one spectrum of tumours known as “Ewing sarcoma family of tumours (ESFT)” [4]. The most common chromosomal other case of stomach metastasis from Ewing’s sarcoma was translocation is t(22;11)(q24;q12) that results in EWS- reported in English literature [12]. FLI-1 fusion, seen in 85-90% of the ESFT. The remainder of the cases (approximately 15%) involves fusion of the 4. Conclusion EWS or FUS gene with a gene closely related to FLI like ERG, FEV, ETV1, and ETV4 [5]. As RT-PCR using com- When a tumour is encountered during follow-up of Ewing’s mercial primers is limited to only the most prevalent sarcoma, metastasis should be considered as one of the diag- EWSR1 fusion transcript, the rarer translocations associ- nostic differentials. ated with ESFT that could go undetected could be the likely explanation for our case being negative for the pathognomonic translocation. Consent Clinically, it is an aggressive tumour and with current multimodality approach (chemotherapy, surgery, and/or Consent was obtained from the participant in this article. 4 Case Reports in Oncological Medicine Conflicts of Interest All authors declare that there are no conflicts of interest regarding the publication of this paper. References [1] S. S. Desai and N. A. Jambhekar, “Pathology of Ewing’s sarco- ma/PNET: current opinion and emerging concepts,” Indian Journal of Orthopaedics, vol. 44, no. 4, pp. 363–368, 2010. [2] G. D. de Palma, S. Masone, M. Rega et al., “Metastatic tumors to the stomach: clinical and endoscopic features,” World Jour- nal of Gastroenterology, vol. 12, no. 45, pp. 7326–7328, 2006. [3] N. Esiashvili, M. Goodman, and R. B. Marcus, “Changes in Incidence and Survival of Ewing Sarcoma Patients Over the Past 3 Decades,” Journal of Pediatric Hematology/Oncology, vol. 30, no. 6, pp. 425–430, 2008. [4] H. E. Grier, “The Ewing family of tumors,” Pediatric Clinics of North America, vol. 44, no. 4, pp. 991–1004, 1997. [5] L. Cironi, N. Riggi, P. Provero et al., “IGF1 is a common target gene of Ewing’s sarcoma fusion proteins in mesenchymal pro- genitor cells,” PLOS ONE, vol. 3, no. 7, article e2634, 2008. [6] M. Paulussen, S. Bielack, H. Jurgens, P. G. Casali, and On behalf of the ESMO Guidelines Working Group, “Ewing’s sar- coma of the bone: ESMO clinical recommendations for diag- nosis, treatment and follow-up,” Annals of Oncology, vol. 20, Supplement 4, pp. iv140–iv142, 2009. [7] M. Paulussen, S. Ahrens, S. Burdach et al., “Primary metastatic (stage IV) Ewing tumor: Survival analysis of 171 patients from the EICESS studies,” Annals of Oncology, vol. 9, no. 3, pp. 275– 281, 1998. [8] K. R. Duchman, Y. Gao, and B. J. Miller, “Prognostic factors for survival in patients with Ewing’s sarcoma using the Surveil- lance, Epidemiology, and End Results (SEER) program data- base,” Cancer Epidemiology, vol. 39, no. 2, pp. 189–195, 2015. [9] J. C. J. C. V. Guzmán, J. Espinosa, R. Cervera, M. Delgado, R. Paton, and J. M. Cordero, “Gastric and colon metastasis from breast cancer: case report, review of the literature, and possible underlying mechanisms,” Breast Cancer: Targets and Therapy, vol. Volume 9, pp. 1–7, 2016. [10] K. Wong, S. W. Serafi, A. S. Bhatia, I. Ibarra, and E. A. Allen, “Melanoma with gastric metastases,” Journal of Community Hospital Internal Medicine Perspectives, vol. 6, no. 4, 2016. [11] C. Bong, I. Thomson, and G. Lampe, “Case report and litera- ture review of Ewing’s sarcoma in the gastrointestinal tract,” Surgical Practice, vol. 22, no. 2, pp. 84–92, 2018. [12] L. B. Dodis, M. W. Bennett, and D. L. Carr-Locke, “Ewing’s sarcoma metastasis to the gastric wall in a 72-year-old patient,” MedGenMed, vol. 8, no. 3, p. 6, 2006. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

A Rare Case of Gastric Metastasis in Ewing’s Sarcoma of the Femur

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Copyright © 2019 Krishna Amulya Koti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 2870302, 4 pages https://doi.org/10.1155/2019/2870302 Case Report 1 1 1 Krishna Amulya Koti , Selvamani Backianathan , Patricia Sebastian , 2 3 4 Leni G. Matthew, Mithun Raam, and Dipti Masih Department of Radiation Oncology, Christian Medical College, Vellore, India Department of Child Health, Christian Medical College, Vellore, India Department of General Surgery, Christian Medical College, Vellore, India Department of Pathology, Christian Medical College, Vellore, India Correspondence should be addressed to Patricia Sebastian; patricia.solomon@gmail.com Received 6 February 2019; Accepted 7 May 2019; Published 14 May 2019 Academic Editor: Raffaele Palmirotta Copyright © 2019 Krishna Amulya Koti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The stomach is a very unusual site of metastasis. Published reports on metastatic lesion in the stomach is generally limited to single case reports and case series. Gastric metastasis in an Ewing’s sarcoma is extremely rare and has been reported in English literature but once to our knowledge. We present a case report of Ewing’s sarcoma of the right proximal femur metastasizing to the stomach. A young female treated for Ewing’s sarcoma of the femur in 2012 presented with gastric metastasis after four years of disease-free interval. She was treated with irinotecan-based chemotherapy followed by total gastrectomy with esophagojejunal anastomosis and radiation therapy. At one-year follow-up, she was disease free. 1. Background resonance imaging (MRI) showed right proximal femur lesion. Biopsy from the same was reported as malignant small Ewing’s sarcoma family of tumours (EFTs) comprises of a round cell tumour suggestive of Ewing’s sarcoma. Tumour spectrum of tumours with a common histological, immuno- cells were immunopositive for CD99 and negative for CD3, histochemical, and chromosomal translocations. It includes CD79a, MPO, and desmin. There was no systemic metastasis Ewing’s sarcoma, extra-skeletal Ewing’s sarcoma, Askin’s on further evaluation. She received 6 cycles of chemotherapy tumour, and peripheral primitive neuroectodermal tumour with vincristine, ifosfamide, doxorubicin, and etoposide [1]. One of the major prognostic factors for survival is the (VIDE) followed by a wide local excision of the tumour with presence of metastasis. The lung and other bones are com- endoprosthesis insertion on 06/09/2012. Surgical specimen mon sites of metastasis; other sites being unusual and rare. histopathology examination did not show viable tumour. The stomach is an uncommon site for primary Ewing’s sar- Margins were free of tumour. She had received further 8 coma; it is a very rare site for metastasis [2]. We report a case cycles of vincristine, ifosfamide, and actinomycin D (VAI). of stomach metastasis in a patient treated for Ewing’s sar- She was on regular follow-up. In 2016, she had presented coma of the extremity. To our knowledge, only one case with abdominal pain with low-grade fever and unquantified has been reported in literature of Ewing’s sarcoma with stom- weight loss. Ultrasound abdomen showed epigastric mass ach metastasis so far. measuring 8cm × 7 5cm. 2.1. Investigation. On computed tomography (CT) of the 2. Case Presentation abdomen and pelvis (Figure 1), a 9 cm × 11 cm × 10 cm (ante- A 14-year-old girl presented to our hospital in February 2012 roposterior×craniocaudal×transverse) well-defined exophytic with complaints of painful swelling of the right thigh for 8 mixed solid-cystic mass was located along the lesser curvature months and difficulty in walking. There was no history of of the stomach bulging into the superior and inferior recesses trauma, fever, or other constitutional symptoms. Magnetic of the lesser sac. The lesion had thick, irregular walls and 2 Case Reports in Oncological Medicine Figure 2: Gastroscopy showing mucosal bulge along the lesser curvature. Figure 1: CT coronal section of the abdomen and pelvis showing a well-defined solid-cystic mass along lesser curvature of the stomach. enhancing solid components interspersed within. Multiple enhancing intratumoral vessels were present. Mass was seen abutting the inferior surface of the left lobe of the liver superi- orly, the pancreatic body posteroinferiorly with no definite invasion. There was no loss of fat plane with adjacent struc- tures. No lymphadenopathy or ascites was noted. Upper gastrointestinal endoscopy showed a mucosal Figure 3: Surgical specimen shows the stomach with tumour. bulge along the lesser curvature of the body of the stomach and proximal antrum (Figure 2). A single deep mucosal ulcer was noted in the mid-body along the lesser curvature with 80-85%), consistent with Ewing’s sarcoma. Hematoxylin surrounding mucosal edema and erythema and friability. and eosin staining showed characteristic uniform cells with Clinical differentials considered were gastrointestinal stromal the round nuclei, small nucleoli with scant-to-moderate clear tumour (GIST), lymphoma, and adenocarcinoma. Metastasis cytoplasm (Figures 4(a) and 4(b)). Margins were free of was considered unlikely in view of the stomach being a rare tumour. Omentum was noted to have focal tumour deposit. site. However, biopsy from the lesion was reported as malig- Eight perigastric lymph nodes with reactive hyperplasia. On nant round cell tumour, immunopositive for CD99 and FLI- immunohistochemistry, the tumour cells were diffusely pos- 1. Immunohistochemistry marker for CK, DOG, desmin, and itive for CD99 (Figure 4(c)). In view of poor response to che- TdT was negative ruling out epithelial tumours, GIST, rhab- motherapy, following discussion with the multidisciplinary domyosarcoma, and lymphoblastic lymphomas, respectively. tumour board, it was decided to rule out anaplastic large- Bone marrow examination did not reveal metastatic infiltra- cell lymphoma. Pathologist had a re-look at her biopsy and tion. No suspicious lesions were seen on bone scintigraphy. surgical specimen slides. Lymphoma and GIST IHC panel was negative. FLI-1 was positive on immunohistochemistry CT thorax was negative for lung metastasis. (Figure 4(d)). Reverse transcription polymerase chain reac- 2.2. Treatment. After discussion with the multidisciplinary tion (RT-PCR) on the gastric resection specimen was nega- tumour board (MDT), it was considered to be a metastatic tive for EWS-FLI-1 types 1 and 2, EWS-ERG, and EWS- lesion from previous Ewing sarcoma and it was planned to FEV translocations. After ruling out epithelial tumours, rhabdomyosarcoma, lymphoma, and GIST, the likelihood offer her systemic chemotherapy followed by assessment for gastrectomy. She received 6 cycles of chemotherapy with iri- of having a RT-PCR negative Ewing’s sarcoma that is known notecan and temozolomide till 07/03/17. to have an incidence of 10-15% was considered. She underwent total gastrectomy with end-to-side esopha- It was decided to offer her radiation therapy in view of gojejunal stapled anastomosis and feeding jejunostomy on poor response to chemotherapy and omental deposit by the MDT team. A renogram was performed prior to initiation 07/04/17 (surgical specimen is seen in Figure 3). At surgery, an exophytic lesion along the lesser curvature of the stomach of RT, and an informed consent was obtained. She received with mucosal involvement adherent to the transverse mesoco- intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 lon was found. There was no ascites or liver or nodal metastasis. fractions, delivered once a day over 5 and a half weeks. She Surgical specimen histopathological examination was received further chemotherapy with irinotecan and temozo- lomide till July 2017. reported as malignant round cell tumour (viable tumour: Case Reports in Oncological Medicine 3 (a) (b) (c) (d) Figure 4: Histopathological images. (a) Hematoxylin and eosin (H&E) 200x magnification. Photomicrograph shows diffuse sheets of tumour cells. (b) H&E 400x uniform cells with round nuclei; small nucleoli with scant-to-moderate clear cytoplasm. (c) Immunohistochemistry (IHC) staining for CD99 shows crisp cytoplasmic membrane staining. (d) IHC for FLI-1 shows moderate nuclear staining in the tumour cells. radiation), the 5-year survival rates for nonmetastatic disease At the last follow-up in March 2018, the patient was doing well without evidence of the disease. ranges from 50 to 70% [6]. Incidence of metastasis is reported to be 20-30%, and the 5-year survival rate has improved from 20% to 30-40% with effective multidrug chemotherapy regi- 3. Discussion mens in metastatic disease [7]. The lung and bones are the Ewing’s sarcoma was first described as diffuse endotheli- most common sites of metastasis. Patients with isolated oma of the bone by James Ewing in 1921. It is the second metastasis to the lung were found to have better prognosis over patients with nonpulmonary metastatic sites [8]. most common primary bone malignancy in children and adolescents [3]. Long bones are the usual sites of presenta- We report a case of Ewing’s sarcoma with stomach metastasis. Gastric metastasis is very rare and was reported tion in Ewing’s sarcoma with the femur being the most common. Ewing’s sarcoma and peripheral primitive neu- in very few breast malignancies and malignant melanomas roectodermal tumours were considered different entities [9, 10]. Few case reports of primary extraosseous Ewing’s sar- coma of the stomach were described [11]. However, there is in the past. However, recent cytogenetic and molecular studies suggest that they indeed are two ends of the same extreme paucity of literature on the stomach being a metasta- tic site for Ewing’s sarcoma. To our knowledge, only one spectrum of tumours known as “Ewing sarcoma family of tumours (ESFT)” [4]. The most common chromosomal other case of stomach metastasis from Ewing’s sarcoma was translocation is t(22;11)(q24;q12) that results in EWS- reported in English literature [12]. FLI-1 fusion, seen in 85-90% of the ESFT. The remainder of the cases (approximately 15%) involves fusion of the 4. Conclusion EWS or FUS gene with a gene closely related to FLI like ERG, FEV, ETV1, and ETV4 [5]. As RT-PCR using com- When a tumour is encountered during follow-up of Ewing’s mercial primers is limited to only the most prevalent sarcoma, metastasis should be considered as one of the diag- EWSR1 fusion transcript, the rarer translocations associ- nostic differentials. ated with ESFT that could go undetected could be the likely explanation for our case being negative for the pathognomonic translocation. Consent Clinically, it is an aggressive tumour and with current multimodality approach (chemotherapy, surgery, and/or Consent was obtained from the participant in this article. 4 Case Reports in Oncological Medicine Conflicts of Interest All authors declare that there are no conflicts of interest regarding the publication of this paper. References [1] S. S. Desai and N. A. Jambhekar, “Pathology of Ewing’s sarco- ma/PNET: current opinion and emerging concepts,” Indian Journal of Orthopaedics, vol. 44, no. 4, pp. 363–368, 2010. [2] G. D. de Palma, S. Masone, M. Rega et al., “Metastatic tumors to the stomach: clinical and endoscopic features,” World Jour- nal of Gastroenterology, vol. 12, no. 45, pp. 7326–7328, 2006. [3] N. Esiashvili, M. Goodman, and R. B. Marcus, “Changes in Incidence and Survival of Ewing Sarcoma Patients Over the Past 3 Decades,” Journal of Pediatric Hematology/Oncology, vol. 30, no. 6, pp. 425–430, 2008. [4] H. E. Grier, “The Ewing family of tumors,” Pediatric Clinics of North America, vol. 44, no. 4, pp. 991–1004, 1997. [5] L. Cironi, N. Riggi, P. Provero et al., “IGF1 is a common target gene of Ewing’s sarcoma fusion proteins in mesenchymal pro- genitor cells,” PLOS ONE, vol. 3, no. 7, article e2634, 2008. [6] M. Paulussen, S. Bielack, H. Jurgens, P. G. Casali, and On behalf of the ESMO Guidelines Working Group, “Ewing’s sar- coma of the bone: ESMO clinical recommendations for diag- nosis, treatment and follow-up,” Annals of Oncology, vol. 20, Supplement 4, pp. iv140–iv142, 2009. [7] M. Paulussen, S. Ahrens, S. Burdach et al., “Primary metastatic (stage IV) Ewing tumor: Survival analysis of 171 patients from the EICESS studies,” Annals of Oncology, vol. 9, no. 3, pp. 275– 281, 1998. [8] K. R. Duchman, Y. Gao, and B. J. Miller, “Prognostic factors for survival in patients with Ewing’s sarcoma using the Surveil- lance, Epidemiology, and End Results (SEER) program data- base,” Cancer Epidemiology, vol. 39, no. 2, pp. 189–195, 2015. [9] J. C. J. C. V. Guzmán, J. Espinosa, R. Cervera, M. Delgado, R. Paton, and J. M. Cordero, “Gastric and colon metastasis from breast cancer: case report, review of the literature, and possible underlying mechanisms,” Breast Cancer: Targets and Therapy, vol. Volume 9, pp. 1–7, 2016. [10] K. Wong, S. W. Serafi, A. S. Bhatia, I. Ibarra, and E. A. Allen, “Melanoma with gastric metastases,” Journal of Community Hospital Internal Medicine Perspectives, vol. 6, no. 4, 2016. [11] C. Bong, I. Thomson, and G. Lampe, “Case report and litera- ture review of Ewing’s sarcoma in the gastrointestinal tract,” Surgical Practice, vol. 22, no. 2, pp. 84–92, 2018. [12] L. B. Dodis, M. W. Bennett, and D. L. Carr-Locke, “Ewing’s sarcoma metastasis to the gastric wall in a 72-year-old patient,” MedGenMed, vol. 8, no. 3, p. 6, 2006. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: May 14, 2019

References