Pediatric Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) in small intestine; a case report.

Pediatric Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) in small intestine; a case report.

Pediatric Ewing’s sarcoma/primitive neuroectodermal tumor (ES/PNET) in small intestine; a case report.

(포스터):
Release Date : 2017. 10. 26(목)
You Sun Kim1, Kyu Sang Lee2, Young Suk Park3, Hyun-Young Kim4, Ji Young Kim5, Jin Min Cho6 , Hyoung Soo Choi6
Seoul National Univesity Children's Hospital Department of Pediatrics1
Seoul National Univesity Bundang Hospital Department of Pathology2
Seoul National Univesity Bundang Hospital Department of Surgery3
Seoul National Univesity Children's Hospital Department of Pediatric Surgery4
Seoul National Univesity Bundang Hospital Department of Radiology5
Seoul National Univesity Bundang Hospital Department of Pediatrics6
김유선1, 이규상2, 박영석3, 김현영4, 김지영5, 조진민6 , 최형수6
서울대학교 어린이병원 소아청소년과1
분당서울대학교병원 병리과2
분당서울대학교병원 외과3
서울대학교 어린이병원 소아외과4
분당서울대학교병원 영상의학과5
분당서울대학교병원 소아청소년과6

Abstract

Ewing’s sarcoma/primitive neuroectodermal tumors (ES/PNETs) are a group of malignant tumors with varying degrees of neuroectodermal differentiation. Once regarded as distinct entities, ES and PNET are now recognized as a same family of tumors based on similar characteristics. Although they may develop in any tissue organs, tumors originating from small intestine are exceedingly rare. A case of 9-year-old girl presenting with abdominal pain, melena, and iron deficiency anemia is reported here. Image work up showed multiple masses in small bowel and omentum with disseminated peritoneal seeding nodules, implying lymphoma as first impression. Pathological reports from explorative diagnostic laparoscopic biopsy showed tumors comprising of densely packed, small round proliferating cells. Immunohistochemically CD99 and CD56 were positive and EWS-FLI1 translocation was observed by dual color, break apart rearrangement fluorescence in situ hybridization suggesting intraabdominal ES/PNET. Neoadjuvant chemotherapy comprising of VDC (vincristine, doxorubicin, cyclophosphamide) alternating every 3 weeks with IE (ifosfamide, etoposide) was performed. Tumor burden decreased gradually during five consecutive cycles of systemic chemotherapy with no evidence of any distant metastasis. Segmental resection of jejunum, where the tumor was located, was conducted. Subsequently, the patient underwent adjuvant chemotherapy. Considering wide abdominal dissemination at the time of diagnosis, high dose chemotherapy followed by autologous peripheral blood stem cell transplantation is currently on schedule. This is the first pediatric case of ES/PNET found in small intestine in Korea.

Keywords: Ewing's Sarcoma, Primitive Neuroectodermal Tumor, Small Intestine