Giri Akanksha, Ramachandran Rajoo, Gopinathan Kiran, Sarangi Pradosh Kumar
Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Radiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND.
Cureus. 2025 Jul 31;17(7):e89114. doi: 10.7759/cureus.89114. eCollection 2025 Jul.
Extraosseous Ewing's sarcoma (EES) is a rare but aggressive soft tissue malignancy of small round blue cells and commonly poses a diagnostic challenge because of its nonspecific anatomical locations and association with other neoplasms. This series of cases presents five uncommon presentations of EES in adult patients in the form of tumors present in the mediastinum, mesentery, right suprarenal gland, infraclavicular soft tissue, and prostate. The clinical presentations varied from rapidly worsening respiratory failure caused by a mediastinal tumor to a preoperatively misdiagnosed gastrointestinal stromal tumor that was subsequently diagnosed as EES post-surgery. Immunohistochemistry (IHC) was crucial in diagnosis, and all the cases were strongly positive for CD99 with supporting markers such as NKX2.2 and FLI-1. Multimodal treatment with chemotherapy (vincristine, doxorubicin (adriamycin), cyclophosphamide, ifosfamide, and etoposide (VDC-IE) regimen), surgery, and radiotherapy was used, and results were variable, with one patient dying of neutropenic sepsis and others having a favorable response to therapy with follow-up. This series puts forward the significance of keeping EES in the differential diagnosis of adult deep-seated or visceral soft tissue masses and the imperative need for prompt histopathological and immunohistochemical correlation to aid proper management.
骨外尤文肉瘤(EES)是一种罕见但侵袭性强的小圆蓝细胞软组织恶性肿瘤,由于其解剖位置不特异且常与其他肿瘤相关,通常在诊断上具有挑战性。本系列病例呈现了EES在成年患者中的五种不常见表现形式,即肿瘤分别位于纵隔、肠系膜、右肾上腺、锁骨下软组织和前列腺。临床表现各异,从纵隔肿瘤导致的呼吸功能迅速恶化到术前误诊为胃肠道间质瘤,术后最终诊断为EES。免疫组织化学(IHC)在诊断中至关重要,所有病例CD99均呈强阳性,并伴有NKX2.2和FLI-1等支持性标志物。采用了化疗(长春新碱、阿霉素(阿霉素)、环磷酰胺、异环磷酰胺和依托泊苷(VDC-IE方案))、手术和放疗的多模式治疗,结果不一,1例患者死于中性粒细胞减少性败血症,其他患者在随访中对治疗反应良好。本系列病例提出了在成年深部或内脏软组织肿块鉴别诊断中考虑EES的重要性,以及迫切需要及时进行组织病理学和免疫组织化学关联以辅助恰当治疗的必要性。