Cytopathological findings of primary pulmonary Ewing family of tumors with EWSR1 translocation: A case report

Abstract

Primary pulmonary neoplasms of the Ewing family of tumors (EFT) are extremely rare and usually occur in adolescents or young adults. Only about 40 cases of pulmonary EFT have been reported in English literature, and no cytological studies have been documented. In this report, we describe the cytopathological findings of a primary pulmonary EFT in an elderly patient. A 70‐year‐old man sought care because of a progressing cough and dyspnea. Chest computed tomography revealed a circumscribed mass of 6 cm in the left upper lobe. Fine needle aspiration cytology and core needle biopsy revealed uniform round cell proliferation. The predominant population consisted of cells with thickened nuclear membranes, finely dispersed chromatin, single distinct nucleoli, and indistinct cytoplasm. The other population consisted of smaller cells with darker chromatin. The cytoplasm stained positive for periodic acid–Schiff stain and was digested by diastase. Immunohistochemistry showed positivity for MIC2 (CD99), and focal positivity for neuron specific enolase, synaptophysin, and chromogranin A. Fluorescence in situ hybridization (FISH) revealed EWSR1 translocation. Although rare, pulmonary EFT cannot be disregarded, regardless of age. When two populations of uniform, round cells are observed, immunohistochemistry with MIC2 (CD99) and cytogenetic analysis by reverse transcription polymerase chain reaction or FISH should be considered. Cytological diagnosis may play an important role in the early diagnosis and treatment of pulmonary EFT.

Outcomes of Ewing sarcoma in adults over 40 years of age from a low-middle income country

“…Analysis of the SEER database from 1973-2008 revealed it to be 13.8% of all ES patients [30]. Approximately 10% were geriatric patients (over 60 years) in our study, and only a few case reports share their experience treating this rare population [31][32][33][34][35]. Extremities were the primary tumour location in 36.4% of cases, and this similar to other studies [16,36].…”

Primary Ewing sarcoma of the lung diagnosed on cytology: Case report with review of literature

“…These cytomorphological findings are similar to those of ES in other sites. In the case report by Mizuguchi et al, similar cytomorphological findings were described; however rosette formation was not observed 5 . Considering the age of the patient, the differential diagnoses considered were neuroendocrine tumour and poorly differentiated synovial sarcoma.…”

“…In the case report by Mizuguchi et al, similar cytomorphological findings were described; however rosette formation was not observed. 5 Considering the age of the patient, the differential diagnoses considered were neuroendocrine tumour and poorly differentiated synovial sarcoma. Immunohistochemistry with cytogenetics and molecular studies play an important role in differentiating these neoplasms from other small round cell tumours.…”

Primary pulmonary Ewing’s sarcoma: rare cause of massive hemothorax in a young girl-case report

“…The cells often show immunohistochemical positivity for various neurofilaments such as CD99, which is a sensitive diagnostic marker. Other markers include vimentin, CD56, Thyroid transcription factor-1(TTF1), cytokeratin 5/6, and caveolin 1, which facilitate differentiation from other small round cell tumors [ 1 , 4 ].…”