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Fine-Needle Aspiration Cytology of Ewing’s Sarcoma of Thoracic Spine with Extension into the Intradural Space

Fine-Needle Aspiration Cytology of Ewing’s Sarcoma of Thoracic Spine with Extension into the... Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2014, Article ID 351386, 3 pages http://dx.doi.org/10.1155/2014/351386 Case Report Fine-Needle Aspiration Cytology of Ewing’s Sarcoma of Thoracic Spine with Extension into the Intradural Space 1 1 2 1 Sandhya Bordia, Sweta Meena, Bijendar Kumar Meena, and Vijay Rajak Department of Pathology, RNT Medical College, Udaipur, Rajasthan 313001, India Department of Radiodiagnosis,RNT MedicalCollege,Udaipur,Rajasthan 313001,India Correspondence should be addressed to Sweta Meena; dr.swetabj@gmail.com Received 17 October 2013; Accepted 23 December 2013; Published 3 February 2014 Academic Editors: K. Aogi and M. W. Bekkenk Copyright © 2014 Sandhya Bordia 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. Ewing’s sarcoma/peripheral primitive neuroectodermal tumor is a small, round, and blue cell malignancy that occurs most oen ft in bone and soft tissues of children and young adults. eTh intraspinal manifestation of the disease is rare, and when present, this is often misdiagnosed with other varieties of primary spinal tumor s. Fine-needle aspiration cytology (FNAC) plays important role in the early diagnosis of these cases. We report such a case of Ewing’s sarcoma of thoracic spine with extension into the intradural space, which was initially suspected to be a case of metastatic lesion in an 18-year-old boy. 1. Introduction lymphocytes. Erythrocyte sedimentation rate was 60 mm at the end of 1 hour. eTh urine examination and bone marrow Ewing’s sarcoma family of tumors are a group of small round- examination did not reveal any abnormality. Tuberculin cell neoplasms, which include Ewing’s sarcoma (EWS), test was negative. Chest radiograph was normal. CT scan primitive neuroectodermal tumor (PNET), Askins tumor, (Figure 1) of the spine showed an expansile lytic lesion of PNET of the bone, and extraosseous Ewing’s sarcoma (ESS) posterior element of D7 vertebrae involving the spinous pro- [1]. Ewing’s sarcoma/peripheral primitive neuroectodermal cess, associated with heterogeneously enhancing soft tissue tumor is presumed to be in neuroectodermal children and component, which was extending from D7 to D9 vertebrae. young adults. eTh intraspinal extraosseous Ewing’s sarcoma The soft tissue component was seen involving the thecal (CNS-ESS) is extremely rare and oeft n misdiagnosed. sac, lamina, and spinous process of D7 and causing com- pression and displacement of spinal cord anteriorly. MRI of the spine (Figure 2) reveals an expansile lesion of posterior 2. Case Report element of D7 involving spinous process and neural arch, associated with fairly large, enhancing soft tissue component An 18-year-old boy was admitted to Neurosurgery Ward of RNT Medical College, Udaipur Rajasthan, with chief {67∗32∗18} in posterior paraspinal region extending from complaints of progressively increasing dullaching pain in the D6-D7 to D8-D9 levels, extending into epidural compart- ment of canal at D6-7 and D7-8, and causing compression lower back and both limbs and tenderness at D7, D8 vertebral region. eTh re was a history of loss of appetite and malaise. and displacement of spinal cord anteriorly with severe sec- ondary central canal stenosis AP diameter approximately The patient was thin built and on general examination there was a mild pallor. Systemic examination did not reveal any 2 mm. FNAC was advised for definite diagnosis. USG guided abnormalities except weakness (power 3/5) in both lower FNAC was done using long 22-gauge disposable needle and 10 mL syringe. Slides were prepared and stained with limbs and decrease in sensation of touch. Investigation revealed haemoglobin 9 gm.%, total leuko- May-Grunwald-Giemsa (MGG). Two slides were reserved cyte count 8200 cells/mm cu with 70% polymorphs and 26% for special stain and studies. FNAC revealed cellular smear 2 Case Reports in Oncological Medicine Figure 1 Figure 3 Figure 4 Figure 2 composed of densely dispersed, small, monomorphic round cells with ne fi nuclear chromatin and round nuclei and scanty clear cytoplasm. Many cells showed irregularly vac- uolated cytoplasm. Occasional rosette formation was also seen (Figures 4 and 6). FNAC diagnosis of malignant small, round-cell tumor, most likely Ewing’s sarcoma, was oer ff ed. Histopathological section revealed small blue round cell with monomorphic appearance. Pseudorosettes were also noted Figure 5 and vascularization was prominent (Figure 5). PAS stain revealed positive intracellular deposit of glycogen (Figure 3). The patient was referred to radiotherapy ward for further management; immunohistochemistry was performed there a peak incidence at 10–15 years. eTh male-to-female ratio is in which the tumor cells exhibited NSE and Vimentin along 3 : 2. Although it can involve any bone, it is more common with diffuse membranous staining for CD-99. in the bones of the lower extremity. In the vertebral column, sacral involvement dominates followed by the lumbar, tho- racic, cervical, and coccygeal regions in order of decreasing 3. Discussion frequency [2]. The dorsal vertebrae are involved in 1% of cases James Ewing described the rfi st case of ES in 1921 [ 1]. Ewing’s [3]. Ewing’s sarcoma is highly malignant round-cell tumor sarcoma is usually seen in the age group of 5–30 years with and has aggressive clinical behaviour and distant metastasis. Case Reports in Oncological Medicine 3 [3] G. B. Greenfield, “Primary malignant tumours of bone,” in Radiology of Bone Diseases,G.B.Greenfield,Ed.,pp. 597–603, J. B. Lippincott, Philadelphia, Pa, USA, 4th edition. [4] G.-J. Kaspers, W. Kamphorst, M. van de Graaff, A. M. van Alphen, and A. J. P. Veerman, “Primary spinal epidural extraoss- eous Ewing’s sarcoma,” Cancer,vol.68, no.3,pp. 648–654, 1991. [5] E.deAlava,A.Kawai,J.H.Healeyetal.,“EWS-FLI1fusiontran- script structure is an independent determinant of prognosis in Ewing’s sarcoma,” Journal of Clinical Oncology,vol.16, no.4,pp. 1248–1255. [6] J.Rosai,“Bone andjoints,”in Surgical Pathology,A.Rosai,Ed., Mosby, St.Louis,Mo, USA, 9thedition,2009. [7] S. E. Kilpatrick and K. R. Geisinger, “Soft tissue sarcomas: the usefulness and limitations of fine-needle aspiration biopsy,” The American Journal of Clinical Pathology,vol.110,no. 1, pp.50–68, Figure 6 CT scan and MRI are essential for establishing the extraskele- tal site of tumor [4]. Cytology and histopathology are essen- tial for definite diagnosis. ES is richly vascular and shows an abundance of thin walled vessels within bfi rovascular septae. ES and pPNET both are the two ends of the spectrum which differ in morphology as well as neuronal differentia- tion. This family of tumors share common cytogenetic and molecular changes which involve the translocation of Ewing’s sarcoma gene on chromosome 22 (22q12) onto chromosome 11 (11q24). The tumor also shares expression of glycoprotein surface antigen mic2/CD99 [5]. Differential diagnosis includes round-cell tumors like metastatic neuroblastoma, rhabdomyosarcoma, and non- Hodgkin lymphoma (NHL). Skeletal Ewing’s sarcoma is knowntohavea5-year survival of 75%. eTh EES andpPNET on the other hand have 38% survival [6]. 4. Conclusion FNAC is a very economic and quick procedure in the diag- nosisofEwing’s sarcomafamilyoftumors. Accurate diagno- sis can be made in deep seated tumor as in our case by ade- quate material under radiological guidance. FNAC is also useful in long term followup [7]. Conflict of Interests eTh authors declare that there is no conflict of interests regarding the publication of this paper. References [1] T. P. Yadav, R. P. Singh, V. K. Gupta, N. K. Chaturvedi, and C. V. Prasad, “Paravertebral extra osseous Ewing’s sarcoma,” Indian Pediatrics, vol. 35, pp. 557–560, 1998. [2] D. Resnik, M. Kyriakas, and G. D. Greenway, “Tumour and tumour like lesions of bone, imaging and thology of specific lesions,” in Diagnosis of Bone and Joint Disorders, D. Resnik, Ed., pp. 3885–3887, WB Saunders Company, Philadelphia, Pa, USA, 3rd edition, 1995. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

Fine-Needle Aspiration Cytology of Ewing’s Sarcoma of Thoracic Spine with Extension into the Intradural Space

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Copyright © 2014 Sandhya Bordia 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 Publishing Corporation Case Reports in Oncological Medicine Volume 2014, Article ID 351386, 3 pages http://dx.doi.org/10.1155/2014/351386 Case Report Fine-Needle Aspiration Cytology of Ewing’s Sarcoma of Thoracic Spine with Extension into the Intradural Space 1 1 2 1 Sandhya Bordia, Sweta Meena, Bijendar Kumar Meena, and Vijay Rajak Department of Pathology, RNT Medical College, Udaipur, Rajasthan 313001, India Department of Radiodiagnosis,RNT MedicalCollege,Udaipur,Rajasthan 313001,India Correspondence should be addressed to Sweta Meena; dr.swetabj@gmail.com Received 17 October 2013; Accepted 23 December 2013; Published 3 February 2014 Academic Editors: K. Aogi and M. W. Bekkenk Copyright © 2014 Sandhya Bordia 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. Ewing’s sarcoma/peripheral primitive neuroectodermal tumor is a small, round, and blue cell malignancy that occurs most oen ft in bone and soft tissues of children and young adults. eTh intraspinal manifestation of the disease is rare, and when present, this is often misdiagnosed with other varieties of primary spinal tumor s. Fine-needle aspiration cytology (FNAC) plays important role in the early diagnosis of these cases. We report such a case of Ewing’s sarcoma of thoracic spine with extension into the intradural space, which was initially suspected to be a case of metastatic lesion in an 18-year-old boy. 1. Introduction lymphocytes. Erythrocyte sedimentation rate was 60 mm at the end of 1 hour. eTh urine examination and bone marrow Ewing’s sarcoma family of tumors are a group of small round- examination did not reveal any abnormality. Tuberculin cell neoplasms, which include Ewing’s sarcoma (EWS), test was negative. Chest radiograph was normal. CT scan primitive neuroectodermal tumor (PNET), Askins tumor, (Figure 1) of the spine showed an expansile lytic lesion of PNET of the bone, and extraosseous Ewing’s sarcoma (ESS) posterior element of D7 vertebrae involving the spinous pro- [1]. Ewing’s sarcoma/peripheral primitive neuroectodermal cess, associated with heterogeneously enhancing soft tissue tumor is presumed to be in neuroectodermal children and component, which was extending from D7 to D9 vertebrae. young adults. eTh intraspinal extraosseous Ewing’s sarcoma The soft tissue component was seen involving the thecal (CNS-ESS) is extremely rare and oeft n misdiagnosed. sac, lamina, and spinous process of D7 and causing com- pression and displacement of spinal cord anteriorly. MRI of the spine (Figure 2) reveals an expansile lesion of posterior 2. Case Report element of D7 involving spinous process and neural arch, associated with fairly large, enhancing soft tissue component An 18-year-old boy was admitted to Neurosurgery Ward of RNT Medical College, Udaipur Rajasthan, with chief {67∗32∗18} in posterior paraspinal region extending from complaints of progressively increasing dullaching pain in the D6-D7 to D8-D9 levels, extending into epidural compart- ment of canal at D6-7 and D7-8, and causing compression lower back and both limbs and tenderness at D7, D8 vertebral region. eTh re was a history of loss of appetite and malaise. and displacement of spinal cord anteriorly with severe sec- ondary central canal stenosis AP diameter approximately The patient was thin built and on general examination there was a mild pallor. Systemic examination did not reveal any 2 mm. FNAC was advised for definite diagnosis. USG guided abnormalities except weakness (power 3/5) in both lower FNAC was done using long 22-gauge disposable needle and 10 mL syringe. Slides were prepared and stained with limbs and decrease in sensation of touch. Investigation revealed haemoglobin 9 gm.%, total leuko- May-Grunwald-Giemsa (MGG). Two slides were reserved cyte count 8200 cells/mm cu with 70% polymorphs and 26% for special stain and studies. FNAC revealed cellular smear 2 Case Reports in Oncological Medicine Figure 1 Figure 3 Figure 4 Figure 2 composed of densely dispersed, small, monomorphic round cells with ne fi nuclear chromatin and round nuclei and scanty clear cytoplasm. Many cells showed irregularly vac- uolated cytoplasm. Occasional rosette formation was also seen (Figures 4 and 6). FNAC diagnosis of malignant small, round-cell tumor, most likely Ewing’s sarcoma, was oer ff ed. Histopathological section revealed small blue round cell with monomorphic appearance. Pseudorosettes were also noted Figure 5 and vascularization was prominent (Figure 5). PAS stain revealed positive intracellular deposit of glycogen (Figure 3). The patient was referred to radiotherapy ward for further management; immunohistochemistry was performed there a peak incidence at 10–15 years. eTh male-to-female ratio is in which the tumor cells exhibited NSE and Vimentin along 3 : 2. Although it can involve any bone, it is more common with diffuse membranous staining for CD-99. in the bones of the lower extremity. In the vertebral column, sacral involvement dominates followed by the lumbar, tho- racic, cervical, and coccygeal regions in order of decreasing 3. Discussion frequency [2]. The dorsal vertebrae are involved in 1% of cases James Ewing described the rfi st case of ES in 1921 [ 1]. Ewing’s [3]. Ewing’s sarcoma is highly malignant round-cell tumor sarcoma is usually seen in the age group of 5–30 years with and has aggressive clinical behaviour and distant metastasis. Case Reports in Oncological Medicine 3 [3] G. B. Greenfield, “Primary malignant tumours of bone,” in Radiology of Bone Diseases,G.B.Greenfield,Ed.,pp. 597–603, J. B. Lippincott, Philadelphia, Pa, USA, 4th edition. [4] G.-J. Kaspers, W. Kamphorst, M. van de Graaff, A. M. van Alphen, and A. J. P. Veerman, “Primary spinal epidural extraoss- eous Ewing’s sarcoma,” Cancer,vol.68, no.3,pp. 648–654, 1991. [5] E.deAlava,A.Kawai,J.H.Healeyetal.,“EWS-FLI1fusiontran- script structure is an independent determinant of prognosis in Ewing’s sarcoma,” Journal of Clinical Oncology,vol.16, no.4,pp. 1248–1255. [6] J.Rosai,“Bone andjoints,”in Surgical Pathology,A.Rosai,Ed., Mosby, St.Louis,Mo, USA, 9thedition,2009. [7] S. E. Kilpatrick and K. R. Geisinger, “Soft tissue sarcomas: the usefulness and limitations of fine-needle aspiration biopsy,” The American Journal of Clinical Pathology,vol.110,no. 1, pp.50–68, Figure 6 CT scan and MRI are essential for establishing the extraskele- tal site of tumor [4]. Cytology and histopathology are essen- tial for definite diagnosis. ES is richly vascular and shows an abundance of thin walled vessels within bfi rovascular septae. ES and pPNET both are the two ends of the spectrum which differ in morphology as well as neuronal differentia- tion. This family of tumors share common cytogenetic and molecular changes which involve the translocation of Ewing’s sarcoma gene on chromosome 22 (22q12) onto chromosome 11 (11q24). The tumor also shares expression of glycoprotein surface antigen mic2/CD99 [5]. Differential diagnosis includes round-cell tumors like metastatic neuroblastoma, rhabdomyosarcoma, and non- Hodgkin lymphoma (NHL). Skeletal Ewing’s sarcoma is knowntohavea5-year survival of 75%. eTh EES andpPNET on the other hand have 38% survival [6]. 4. Conclusion FNAC is a very economic and quick procedure in the diag- nosisofEwing’s sarcomafamilyoftumors. Accurate diagno- sis can be made in deep seated tumor as in our case by ade- quate material under radiological guidance. FNAC is also useful in long term followup [7]. Conflict of Interests eTh authors declare that there is no conflict of interests regarding the publication of this paper. References [1] T. P. Yadav, R. P. Singh, V. K. Gupta, N. K. Chaturvedi, and C. V. Prasad, “Paravertebral extra osseous Ewing’s sarcoma,” Indian Pediatrics, vol. 35, pp. 557–560, 1998. [2] D. Resnik, M. Kyriakas, and G. D. Greenway, “Tumour and tumour like lesions of bone, imaging and thology of specific lesions,” in Diagnosis of Bone and Joint Disorders, D. Resnik, Ed., pp. 3885–3887, WB Saunders Company, Philadelphia, Pa, USA, 3rd edition, 1995. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: Feb 3, 2014

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