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Primitive neuroectodermal tumor of the lung.

Primitive neuroectodermal tumors occur most frequently in bone and soft tissue but have been reported in other locations. Primary lung primitive neuroectodermal tumors without pleural or chest wall involvement are extremely rare. We present a case with immunohistochemical and ultrastructural studies and follow-up of the patient. An 18-year-old man presented with hemoptysis. Chest radiographs revealed a right middle lobe mass, and bronchoscopy showed an endobronchial tumor. The lesion was resected by middle lobectomy. After 2 years, a local recurrence was treated by pneumonectomy. The patient died after surgery. Histologically, the tumor was composed of uniform cells with round nuclei and scanty cytoplasm arranged in cohesive lobules with occasional rosette formation. Immunohistochemically, the tumor was positive for vimentin, CD99, neuron-specific enolase, and neurofilaments. Ultrastructural study revealed neurosecretory granules and cytoplasmic processes. Our case shows the value of immunohistochemistry and electron microscopy in the diagnosis of primitive neuroectodermal tumors in unusual locations.

Adolescent↗

Primitive neuroectodermal tumor of the stomach.

Ewing sarcoma/primitive neuroectodermal tumor is classically a tumor of the soft tissue or bone in children and young adults, but several cases have been described in patients of all ages. Within the last decade, the clinicopathologic spectrum of Ewing sarcoma/primitive neuroectodermal tumor has been markedly expanded by recognition that the tumor may also have a visceral origin. We describe a case of primitive neuroectodermal tumor arising in the stomach of a 66-year-old woman. The neoplasm was excised using a radical surgical procedure. Microscopically, the tumor was made up of solid nests and sheets of round cells. Immunohistochemically, the tumor cells showed immunoreactivity for CD99, S100, neuron-specific enolase, and vimentin. A multiplex real-time polymerase chain reaction assay detected an EWS-ERG fusion. To our knowledge, this is the first description of a primitive neuroectodermal tumor arising in the stomach.

Aged↗

Computed tomography of primitive neuroectodermal tumors.

The primitive neuroectodermal tumor is a neoplasm of young individuals that occurs predominantly in the supratentorial compartment. It appears on computed tomography as a bulky mass, often with calcification with predominantly homogeneous enhancement but on occasion with cystic or necrotic areas. Cerebrospinal fluid seeding was observed in more than half the cases in our series. The patients had a short survival period (7-24 months). Despite surgery, radiation, and chemotherapy, further growth of this tumor has not been prevented.

Adolescent↗

Immunohistochemical analysis of INI1 protein in malignant pediatric CNS tumors: Lack of INI1 in atypical teratoid/rhabdoid tumors and in a fraction of primitive neuroectodermal tumors without rhabdoid phenotype.

Immunohistochemical lack of nuclear INI1 protein expression has been recently described as characteristic finding in atypical teratoid/rhabdoid tumors (AT/RTs), and has been suggested as useful marker to distinguish AT/RTs from other malignant pediatric central nervous system (CNS) tumors. In this study, we examined a large series of malignant pediatric CNS tumors to determine the immunohistochemical expression of INI1 protein in different malignant pediatric tumor entities. Archival paraffin-embedded biopsy specimens of 289 malignant pediatric CNS tumors including medulloblastomas, supratentorial primitive neuroectodermal tumors, glioblastomas, anaplastic astrocytomas, anaplastic ependymomas, choroid plexus carcinomas, germ cell tumors, and AT/RTs were analyzed immunohistochemically for expression of nuclear INI1 protein. Positive INI1 staining was observed in 263 tumors. Lack of INI1 protein was detectable in 26 tumors. Seventeen of the 26 tumors showed morphologically characteristic features of AT/RTs, whereas 9 embryonal tumors did not display rhabdoid features. Tumors without rhabdoid phenotype but lack of INI1 showed an aggressive clinical course and poor response to conventional treatment regimens. In summary, immunohistochemical expression of INI1 protein is lacking in tumors displaying characteristic morphologic features of AT/RT. Furthermore, a certain number of embryonal tumors without rhabdoid features but lack of INI1 protein and aggressive biologic behavior can be detected. We conclude that INI1 protein analysis should be routinely performed in all malignant pediatric embryonal CNS tumors to detect cases with lack of INI1 protein, because patients with these tumors are likely to benefit from intensified treatment.

Biomarkers, Tumor↗

Loss of heterozygosity on 6q, 16q, and 17p in human central nervous system primitive neuroectodermal tumors.

The loss of genetic material from specific chromosomal locations in a given tumor type has been taken for evidence of the importance of tumor suppressor genes at these loci in the genesis of the tumor. The primitive neuroectodermal tumor of the central nervous system has such a loss on 17p in one-third of tumors. In this report, a detailed analysis of 17p loss in 23 tumors has been performed using 10 probes mapping to this region. In addition, an analysis for allelic deletion on chromosomes 6q, 16q, and 22q has been performed. Six of the 23 tumors showed loss of markers on 17p, and the area of common loss spanned 17p11.2 to 17pter. Five of 23 tumors showed loss of markers on 6q, and 3 showed loss on 16q. No tumor lost markers on 22q. Only one tumor showed loss at more than one location. These data suggest that primitive neuroectodermal tumors either are a heterogeneous group of tumors with more than one mechanism leading to a tumor or that more than one recessive oncogene may play a role in the genesis of these tumors.

Adult↗

Primitive neuroectodermal tumor: a newly recognized cause of early fetal death.

Reviews in the literature of fetal and neonatal neoplasms deal only with congenital tumors, that is, tumors presenting at or shortly after birth. Virtually nothing is known about neoplasms occurring in the embryonal period or early fetal life. We report five small macerated fetuses with a very primitive embryonal tumor of neuroectodermal origin. The tumor characteristically showed massive vascular permeation. Expulsion of the fetus occurred during the fourth or fifth month of pregnancy. It is suggested that this primitive neuroectodermal tumor is a "new" cause of spontaneous late abortion.

Blood Vessels↗

Cytogenetic and histopathologic studies of congenital supratentorial primitive neuroectodermal tumors: a case report.

Primitive neuroectodermal tumors (PNET) represent about 25% of primary central nervous system tumors in childhood, but congenital PNETs are rare. Cytogenetic studies and studies on molecular pathology have identified several genetic alterations in medulloblastoma, but molecular investigations on supratentorial PNETs are infrequent. We present a male newborn with a large congenital PNET of the right cerebral hemisphere and the molecular analysis of the tumor. Tumor tissue was investigated by routine histology and immunohistochemistry. Fluorescence in-situ hybridization was carried out on native tumor tissue to investigate deletions on chromosome 17p and to analyze c-Myc or N-Myc amplifications. Histologic examination revealed a primitive neuroectodermal tumor with massive extension covering almost the entire right hemisphere. Genetic analysis of the native tumor tissue of our patient excluded a deletion of chromosome 17p. An amplification of the c-Myc or N-Myc oncogene was absent using fluorescence in-situ hybridization. Despite unremarkable genetic analysis in our case prognosis was poor, suggesting that there are additional, yet unknown constitutional genetic aberrations in the pathogenesis of congenital supratentorial PNET.

Biomarkers, Tumor↗

Primitive neuroectodermal tumor of the vagina.

OBJECTIVES: Primitive neuroectodermal tumor is grouped together with Ewing sarcoma of the bone, but its presentation includes a wider age range and more central locations than its osseous counterpart. Presentation in vagina is exceedingly rare. CASE: A 34-year-old woman with personal history of kidney transplant presented with a painless vaginal mass. After surgical excision, pathology results demonstrated a primitive neuroectodermal tumor. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy. After 20 months postexcision, there is no clinical nor radiographic evidence of recurrence. CONCLUSIONS: This is the second case of primitive neuroectodermal tumor located in the vagina reported in the literature.

Adult↗

[Primitive neuroectodermal tumor. Ewing's sarcoma].

Primitive neuroectodermal tumor is an extraordinarily rare primary tumor in the kidney and can be mistaken for a variety of other round cell tumors. It is important to recognize each of these entities, because each carries unique therapeutic and prognostic implications. However, accurate diagnosis of these tumors is hindered by their significant morphologic overlap and complicated by their rarity. These neplasm are highly aggressive that tend to recurence and to metastatize. Standard therapy combining surgery, chemotherapy, radiation and genetic therapy. We report a case of primitive neuroectodermal tumor of the kidney in a 50 year old female patient.

Female↗

Small round blue cell tumors in bone: prognostic factors correlated to Ewing's sarcoma and neuroectodermal tumors.

Ewing's sarcoma and peripheral neuroectodermal tumors are the most common small round blue cell tumors of bone. Accurate prognostic factors are required to define guidelines to standardize the treatment modalities and to adapt these modalities to the potential evolution of the disease. The various factors that have emerged in the literature as influences on the outcome of patients with Ewing's sarcoma or peripheral neuroectodermal tumors of bone are considered in this review. The presence of metastases at the clinical onset of the disease represents the most adverse prognostic factor. For nonmetastatic patients, axial location appears to be the most unfavorable factor, despite initial tumor volume, by showing that the tumor burden could be a more appropriate indicator of patient outcome. The importance of a local control of the disease by surgery has been emphasized, and the value of the histopathologic evaluation of the response to chemotherapy has been stressed.

Age Factors↗

Mutations of the INI1 rhabdoid tumor suppressor gene in medulloblastomas and primitive neuroectodermal tumors of the central nervous system.

Germ-line and somatic mutations of the hSNF5/INI1 gene have been reported in atypical teratoid/rhabdoid tumors (AT/RTs) of the brain, consistent with its role as a tumor suppressor gene. In the present study, we determined the frequency of deletions and mutations of INI1 in 52 children whose original diagnosis was medulloblastoma (MB) or primitive neuroectodermal tumor (PNET) of the central nervous system. Mutations were detected in DNA isolated from four tumors, all from children less than 3 years of age at diagnosis. Two of the four were reviewed and reclassified as atypical teratoid tumor, whereas there was insufficient material to establish this diagnosis in the two remaining cases. The relatively low frequency of mutations, even in a large series of infants, suggests that loss of sequences from chromosome 22 and/or mutations of INI1 do not account for the poor prognosis of children with MB or PNET who are less than 3 years of age at diagnosis. Nevertheless, chromosome 22 deletion and INI1-mutation analysis of infants with MB/PNET should be considered for all children who are less than 1 year of age. Detection of these mutations suggests that the child has an AT/RT, rather than a MB/PNET, a finding with important prognostic value.

Adolescent↗

Primitive neuroectodermal tumor of maxilla in an adult.

Primitive neuroectodermal tumor is primarily a central nervous system tumor. These tumors are generally manifest in infancy or early childhood. The following article reports a rare case of primitive neuroectodermal tumor in posterior maxilla in an adult. Treatment for primitive neuroectodermal tumor in extracranial sites in adults is not clearly defined in the literature. This case was treated by combined chemotherapy followed by radiotherapy, which failed to cause regression of the lesion.

Adult↗

Malignant round cell tumor of bone with neural differentiation (neuroectodermal tumor).

A malignant round cell tumor primary in bone is reported in a young girl, showing histologically rosette formation and pseudoalveolar spaces. Vimentin, NSE, and S-100 were positive. Electron microscopy demonstrated abundant glycogen and neural features such as cell processes, microtubules, and occasional dense-core granules. Whether this neuroectodermal tumor represents a separate entity or is a variant of Ewing's sarcoma should wait for further experience, in the light of recent evidence suggesting that Ewing's sarcoma arises from primitive multipotential cells.

Adolescent↗

Bone morphogenetic proteins-2 and -4 attenuate apoptosis in a cerebellar primitive neuroectodermal tumor cell line.

Similarities between primitive neuroectodermal tumors and central nervous system (CNS) progenitor cells have evoked interest in the response of these tumors to endogenous growth factors. The bone morphogenetic proteins (BMPs) have recently been found to regulate survival and differentiation of CNS progenitor cell populations. In this study, we investigated the effects of BMP-2, BMP-4, and BMP-6 on the undifferentiated cerebellar primitive neuroectodermal tumor or medulloblastoma cell line DAOY. Analysis by reverse transcriptase-polymerase chain reaction showed that mRNAs for type IA and type II BMP receptors were present in control cultures. In cultures treated with BMP-2, mRNAs for BMP receptor type IB and the activin R-I receptor became evident. Cultures were analyzed for total cell counts, proliferating cell nuclear antigen (PCNA), and apoptotic DNA fragmentation. There was a significant increase in total cell number in the BMP-2 and BMP-4 treatment groups, without any change in PCNA reactivity, and a dramatic decrease in the proportion of apoptotic nuclei at concentrations of BMP-2 and BMP-4 above 5 ng/ml (P<0.001). These effects were not observed with BMP-6, TGF-beta1 or GDNF. These results suggest that the increase in total cell number is due to the attenuation of apoptosis by BMP-2 and BMP-4. The anti-apoptotic effect of BMP-2 and BMP-4 on this neuroectodermal cell line has potential clinical implications for neuroectodermal tumors.

Apoptosis↗

Animal models of medulloblastomas and related primitive neuroectodermal tumors. A review.

Primitive neuroectodermal tumors (PNET) belong to a family of pediatric neoplasms of the central nervous system (CNS) that are composed predominantly of primitive neuroepithelial cells. Among the different CNS PNET, those arising in the posterior fossa (i.e. medulloblastomas) are prototypical of this group of brain tumors. The basic cell biology of PNET is incompletely understood, but recent studies of human PNET biopsies and cell lines derived therefrom demonstrate that neoplastic cells in human PNET recapitulate many of the phenotypic properties of immature CNS neurons or their progenitors. Based on these findings, it has been possible to develop several animal models of human PNET that will enhance efforts to gain fundamental insights into the induction and progression of PNET. In addition, these model systems will enable emerging gene therapies to be targeted specifically for human PNET. Accordingly, this review summarizes current understanding of the cell biology of human PNET, particularly medulloblastomas, and it highlights the most salient features of representative in vivo model systems of human PNET that are relevant to future studies of these tumors.

Animals↗

Differentiation, proliferation and apoptosis in primary and recurrent primitive neuroectodermal tumors of childhood.

Primitive neuroectodermal tumors (PNETs) of the CNS are a group of embryonal tumors composed of small undifferentiated or poorly differentiated cells. Infratentorially located PNETs are a synonym for medulloblastomas. In this study 31 PNETs, including 5 recurrent tumors, were examined. All children underwent neurosurgery and chemotherapy according to the HIT and HIT-SKK protocols. The specimens were investigated both for their expression of nine immunohistochemical markers for neuronal, astrocytic, mesenchymal and epithelial differentiation and for their proliferation. Results regarding cellular differentiation were confirmed ultrastructurally. Apoptosis was detected by labeling the 3'OH ends generated by DNA fragmentation and by electron microscopy. Glial differentiation was shown to have a prognostic relevance, with an elevated (twofold) risk of recurrence. Neuronal differentiation also indicated a tendency to poor prognosis. Those tumors that recurred later showed an increased proliferation rate (69%) compared with nonrecurrent tumors (58%). Apoptosis was identified in all tumors examined. The proportion of apoptotic cells could not be related to the effect of therapy. These results indicate that cellular differentiation may be a useful predicative factor for the prognosis of cerebral PNETs.

Adolescent↗

[A case of primitive neuroectodermal tumor from rib].

Primitive Neuroectodermal Tumor (PNET) is a small round cell malignancy arising in bone and soft tissue. With the progress of immunohisto-chemical and ultrastructural studies, the tumor has getting attention. We report a rare case of PNET arising from rib. A 19-year-old man was admitted to our hospital complaining of chest and back pain. The tumor arised from 5th rib and en bloc resection was performed. Pathological diagnosis was PNET. After the operation, he is doing well, except being treated with chemotherapy (T9-protocol).

Adult↗

[A rare primitive neuroectodermal tumor: the medulloepithelioma].

Primitive neuroectodermal tumors (PNET) is a name used to describe rare and highly malignant tumors composed of undifferentiated cells resembling germinal or matrix cells of the embryonic neural tube. These tumors occur most commonly in the first decade of life, and have a particular radiological, histological and evolution features. We report a case of a PNET in an 8-year-old boy who presented intracranial hypertension studied with computed tomography scan, which demonstrated a sharply circumscribed expansive mass in the frontoparietal deep white matter, with a large cystic component, which was considered at first as a glial tumor. It was treated by total excision, and the histologic study demonstrated a medulloepithelioma. We studied the concept of PNET and their pathological, radiological and prognostic features.

Brain↗