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PubMed2004

Ewing's sarcoma and primitive neuroectodermal tumor of hand and forearm. Experience of the Cooperative Ewing's Sarcoma Study Group.

PURPOSE: Because Ewing's sarcoma (EWS) is extremely rare in the hand and forearm, only limited data are available for planning treatment or predicting prognosis. METHODS: Data of 33 patients with EWS of the forearm or hand who were enrolled in studies of the German Association for Paediatric Oncology/Haematology and the European Intergroup Cooperative Ewing's Sarcoma Study Group were analyzed. Patients received neoadjuvant multi-agent chemotherapy according to the valid protocol. Local treatment consisted of surgery (n=7), radiotherapy (n=7), or a combination of both (n=19). RESULTS: The 5/10-year overall survival rate was 84.1% (95% CI: 71.2-96.9)/74.1% (95% CI: 56.8-91.5), and both 5/10-year event-free survival rate were 71.3% (95% CI: 55.4-87.1). Only one of seven patients with secondary metastases was in remission at the time of analysis. One patient with local recurrence and another with primary metastases died. Altogether, eight of 33 patients died of their disease. The event-free survival rate was 80.6% in patients with good response to chemotherapy and 33.3% in patients with poor response. Surgery in combination with radiotherapy achieved a higher survival rate compared with radiotherapy or surgery alone. One out of two patients with non-wide margins of resection died of disease. CONCLUSIONS: The results demonstrate a remarkably high survival rate for patients with EWS of the hand and forearm.

Adolescent↗
PubMed2006

Therapy-related myelodysplasia and acute myeloid leukemia after Ewing sarcoma and primitive neuroectodermal tumor of bone: A report from the Children's Oncology Group.

This study describes the magnitude of risk of therapy-related myelodysplasia and acute myeloid leukemia (t-MDS/AML) in 578 individuals diagnosed with Ewing sarcoma and enrolled on Children's Oncology Group therapeutic protocol, INT-0091. Between 1988 and 1992, patients with or without metastatic disease were randomized to receive doxorubicin, vincristine, cyclophosphamide, and dactinomycin (regimen A) or these 4 drugs alternating with etoposide and ifosfamide (regimen B). Between 1992 and 1994, patients with metastatic disease were nonrandomly assigned to receive high-intensity therapy (regimen C: regimen B therapy with higher doses of doxorubicin, cyclophosphamide, and ifosfamide). Median age at diagnosis of Ewing sarcoma was 12 years, and median length of follow-up, 8 years. Eleven patients developed t-MDS/AML, resulting in a cumulative incidence of 2% at 5 years. While patients treated on regimens A and B were at a low risk for development of t-MDS/AML (cumulative incidence: 0.4% and 0.9% at 5 years, respectively), patients treated on regimen C were at a 16-fold increased risk of developing t-MDS/AML (cumulative incidence: 11% at 5 years), when compared with those treated on regimen A. Increasing exposure to ifosfamide from 90 to 140 g/m2, cyclophosphamide from 9.6 to 17.6 g/m2, and doxorubicin from 375 to 450 mg/m2 increased the risk of t-MDS/AML significantly.

Acute Disease↗
PubMed1996

Updated results of a pilot study of low dose craniospinal irradiation plus chemotherapy for children under five with cerebellar primitive neuroectodermal tumors (medulloblastoma).

PURPOSE: Children under 5 years old with medulloblastoma (MB) have a poor prognosis. They are more susceptible to the deleterious effects of craniospinal irradiation (CSART) and have a higher relapse rate when treated with low-dose CSART alone. We, thus, embarked on a prospective trial testing the usefulness of very low dose CSART and adjuvant chemotherapy. This is an update of a previous report on these patients. METHODS AND MATERIALS: Between January 1988 and March 1990, 10 patients with medulloblastoma were treated using 18 Gy radiation therapy (RT) to the craniospinal axis, a posterior fossa (PF) boost to 50.4-55.8 Gy and chemotherapy consisting of vincristine (VCR) weekly during RT. This was followed by VCR, cis-diamminedichloroplatinum (CDDP), and lomustine (CCNU) for eight, 6-week cycles. Patients between 18 and 60 months of age without evidence of tumor dissemination were eligible for study. Follow-up was available until September 1994 with a median follow-up for living patients of 6.3 years from diagnosis. RESULTS: Actuarial survival at over 6 years is 70 +/- 20%. Three of the 10 patients relapsed and died. In one patient, the relapse developed in the spine and brain outside the posterior fossa, in the second, concurrently in the posterior fossa, brain and spine, and the third, only in the spine. One surviving child developed a brain stem infarct 4.8 years after diagnosis and has since almost fully recovered. A mean intelligence quotient (IQ) score of 103 in six patients surviving at least 1 year is unchanged from the baseline group score of 107. Five children tested at baseline and 2 years following treatment had IQ scores of 101 and 102, respectively. Six children tested at baseline and at 3 years had IQ scores of 106 and 96, respectively. Excluding the child tested shortly after his brain stem infarct, baseline and 3 year IQ scores were 103 and 97, respectively. Five of the seven long-term survivors grew at rates significantly below their expected velocities during the follow-up period, while the others grew normally. Three patients have received growth hormone, and none have required thyroid replacement. CONCLUSIONS: These data suggest that medulloblastoma patients can be cured with chemotherapy and reduced doses of craniospinal irradiation. The low doses of CSART given by us in conjunction with cis-platin-based chemotherapy produce minimal neurocognitive damage. Growth velocities in very young children so treated are, however, dramatically reduced. Better means of improving the therapeutic ratio are still needed.

Age Factors↗
PubMed2004

Fenretinide cytotoxicity for Ewing's sarcoma and primitive neuroectodermal tumor cell lines is decreased by hypoxia and synergistically enhanced by ceramide modulators.

Patients with disseminated Ewing's family of tumors (ESFT) often experience drug-resistant relapse. We hypothesize that targeting minimal residual disease with the cytotoxic retinoid N-(4-hydroxyphenyl) retinamide (4-HPR; fenretinide) may decrease relapse. We determined the following: (a) 4-HPR cytotoxicity against 12 ESFT cell lines in vitro; (b) whether 4-HPR increased ceramide species (saturated and desaturated ceramides); (c) whether physiological hypoxia (2% O(2)) affected cytotoxicity, mitochondrial membrane potential (DeltaPsi(m)) change, or ceramide species or reactive oxygen species levels; (d) whether cytotoxicity was enhanced by l-threo-dihydrosphingosine (safingol); (e) whether physiological hypoxia increased acid ceramidase (AC) expression; and (f) the effect of the AC inhibitor N-oleoyl-ethanolamine (NOE) on cytotoxicity and ceramide species. Ceramide species were quantified by thin-layer chromatography and scintillography. Cytotoxicity was measured by a fluorescence-based assay using digital imaging microscopy (DIMSCAN). Gene expression profiling was performed by oligonucleotide array analysis. We observed, in 12 cell lines tested in normoxia (20% O(2)), that the mean 4-HPR LC(99) (the drug concentration lethal to 99% of cells) = 6.1 +/- 5.4 microm (range, 1.7-21.8 microm); safingol (1-3 microm) synergistically increased 4-HPR cytotoxicity and reduced the mean 4-HPR LC(99) to 3.2 +/- 1.7 microm (range, 2.0-8.0 microm; combination index < 1). 4-HPR increased ceramide species in the three cell lines tested (up to 9-fold; P < 0.05). Hypoxia (2% O(2)) reduced ceramide species increase, DeltaPsi(m) loss, reactive oxygen species increase (P < 0.05), and 4-HPR cytotoxicity (P = 0.05; 4-HPR LC(99), 19.7 +/- 23.9 microm; range, 2.3-91.4). However, hypoxia affected 4-HPR + safingol cytotoxicity to a lesser extent (P = 0.04; 4-HPR LC(99), 4.9 +/- 2.3 microm; range, 2.0-8.2). Hypoxia increased AC RNA expression; the AC inhibitor NOE enhanced 4-HPR-induced ceramide species increase and cytotoxicity. The antioxidant N-acetyl-l-cysteine somewhat reduced 4-HPR cytotoxicity but did not affect ceramide species increase. We conclude the following: (a) 4-HPR was active against ESFT cell lines in vitro at concentrations achievable clinically, but activity was decreased in hypoxia; and (b) combining 4-HPR with ceramide modulators synergized 4-HPR cytotoxicity in normoxia and hypoxia.

Acetylcysteine↗
PubMed1984

HNK-1-defined antigen detected in paraffin-embedded neuroectoderm tumors and those derived from cells of the amine precursor uptake and decarboxylation system.

The reactivity of the HNK-1 monoclonal antibody that, besides a subset of hematopoietic cells with natural killer activity, also detects neuroectodermal cells, was screened on 153 human tumors. Immunoperoxidase staining of paraffin sections revealed that HNK-1 detects neuroectoderm-derived cancers and tumors with endocrine activity. Because the antigen detected by HNK-1 is well conserved in paraffin sections, this antibody is of potential diagnostic value in routine histopathology and might help to elucidate the histogenesis of some poorly understood tumors.

Adult↗
PubMed1977

[Neuroectodermal tumors of the skin (a normative study)].

A group of bioptically examined neuroectodermal tumours of the skin and soft tissues consisting, in particular, of 170 Schwannomas and 350 tumours has been reevaluated in a retrospective study. The following common classification of these tumours has been recommended: I. Tumours of Schwann's cells: 1. neurilemmoma [A and B], 2. neurofibroma [with the following variants v. Recklinghausen's type, plexiform, pigmented, Paccinian, with Meissner-Wagner's bodies and meningiomatous], 3. amputation neuroma, 4. neurosarcoma, 5. others. II. Melanogenic tumours: A. pigmented naevi (junction, mixed, intradermal, epithelioid, clear cell, halo, neurocutaneous, fibrous, blue, proliferating blue, melanotic progonoma, others). -B. praecancerous melanosis. -C. malignant melanoblastoma (common type, from praecancerosis). III. Tumours of ganglion cells: 1. ganglioneuroma, 2. neuroblastoma, 3. paragangliomas (with granules, without granules, alveolar soft part sarcoma).

Ganglioneuroma↗
PubMed1975

[Histochemistry of the oxidation-reduction enzymes in the cells of neuroectodermal tumors].

The activity of 8 enzymes (dehydrogenase and diaphorase) in cells of 110 neuroectodermal tumours was studied. The overall assessment showed that the activity of these enzymes varied: the highest was noted for NAD-diaphorase and lactadehydrogenase, the lowest--for enzymes of Krebs' cycle. The activity of dehydrogenase and diaphorase was different in neuroectodermal tumours of different origin. Not infrequently, there was observed "enzymatic polymorphism" of the cells of one and the same tumour. A higher activity of these enzymes in tumour cells, as a rule, correlated with a greater amount of cytoplasma and with a shift to the latter of the nucleo-cytoplasmatic ratio. Metabolism of tumour and reactively hypertrophied astrocytes, as judged by some histochemical findings, showed traits of similarity.

Alcohol Oxidoreductases↗
PubMedDate not supplied

[Modern aspects of treatment of medulloblastomas/primitive neuroectodermal tumors of the posterior cranial fossa in children].

The authors present 34 medulloblastoma/primitive neuroectodermal tumours of the posterior fossa in children operated during the last ten years (1979-1989). Total removal of tumours has been performed in 13, and maximal-subtotal resection in 19 patients. Only four tumours were classified as small (group T1-T2). Partial reduction and biopsy were possible in four cases. The average period from surgery to the beginning of radio-oncologic treatment was 31 days. Radio- and chemotherapy were applied according to international standards. Permanent cerebrospinal fluid derivation preceded surgery in 9 patients (VA shunt in 6 and VP in 3) and after surgery of the posterior fossa in four children. Early postsurgical mortality rate, related to the first five years of this study, was 5.6%. Seven children (20.6%) survived from five to ten years after operation. The authors are advocating for standardization of diagnostical and surgical procedures, and for unification of postoperative control with intention to obtain longer duration of survival of these seriously sick children.

Adolescent↗
PubMedDate not supplied

Peripheral primitive neuroectodermal tumor with postchemotherapy neuroblastoma-like differentiation.

We report the case of an 11-year-old girl with a retroperitoneal tumor in the left upper quadrant. The girl was admitted to hospital with weight loss and a painless abdominal mass that on biopsy was diagnosed as a peripheral primitive neuroectodermal tumor/Ewing sarcoma (pPNET/EWS) of the soft tissue. The patient underwent chemotherapy followed by surgical resection of the tumor 5 months after diagnosis. The posttreatment residual viable tumor showed a morphologic appearance resembling a neuroblastoma. Interphase and metaphase fluorescent in situ hybridization (FISH) studies performed on the pretreatment and posttreatment samples showed the presence of a t(11;22) rearrangement resulting in EWSR1/FLI1 gene fusion consistent with pPNET/EWS in both specimens. This case is unusual in the sense of showing the typical gene fusion for pPNET/EWS both in the pretherapy sample with the typical morphological appearance of this tumor and in the posttherapy specimen showing neural differentiation suggestive of a neuroblastoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Malignant peripheral neuroectodermal tumors. Histological and immunohistological conditions in 41 cases].

In view of the personal observation that malignant peripheral neuroectodermal tumours (MPNT) can present different histological growth patterns, 41 cases of MPNT were histologically and immunohistochemically studied. The median age of the 41 patients was 15 years (range: 9 months - 23 years). There were 27 males and 14 females. Most tumours (23/41) were located in the thoracopulmonary region. In 31/41 cases there was bone as well as soft tissue involvement. The following histopathological patterns were found: Ewing's sarcoma-like (n = 7), atypical Ewing's sarcoma-like (n = 4), neuroblastoma-like (n = 8), rhabdomyosarcoma-like (n = 8), and hemangiopericytoma-like (n = 1). In 2 cases combined patterns were noted, one tumour being characterized by neuroblastoma-like and Burkitt's lymphoma-like features. Most cases of MPNT differed from the cytological features of typical Ewing's sarcoma in that they contained hyperchromatic nuclei with distinct nucleoli. Some reticulin fibrils were found in between the cells of some cases. Immunohistochemically, 19/23 cases reacted positively to vimentin, 29/32 to neuron specific enolase (NSE), 16/28 to protein S-100, and 1/9 to glial fibrillary acidic protein. 12/24 cases reacted positively to NSE and protein S-100. Neurofilaments and desmin were not found in the formalin fixed material of the present study. The results show that most cases of MPNT can be distinguished from typical Ewing's sarcoma by cytological and histological findings. Differential diagnosis from atypical Ewing's sarcoma, neuroblastoma, and rhabdomyosarcoma is possible by immunohistochemistry.

Adolescent↗
PubMed1987

[Intracranial manifestation of so-called "melanotic neuroectodermal tumor of infancy"--a choristoma with neural crest potentials].

A case is reported of so-called "melanotic neuroectodermal tumour of infancy" (= MNTI) in a female newborn. The tumour, whose localization was intracranial, but extracerebral, could be removed subtotally. A further 22 cases of the MNTI with neurocranial manifestations reported in the literature, but differing from our case in their extracranial growth, are listed for comparison. We believe that the neural crest is the histogenic origin of the MNTI and, therefore, our proposed definition is: "Christoma with neural crest potencies."

Brain Neoplasms↗
PubMedDate not supplied

Preferential expression of the dbl proto-oncogene in some neuroectodermal tumors.

The dbl oncogene belongs to a unique class of human transforming genes. The dbl proto-oncogene is activated by substitution of the 5' portion of the gene with an unrelated human sequence. The proto-oncogene product is distributed between the soluble and membrane fractions of the cytoplasm and its function remains still unknown. In order to understand the biological role of dbl in human malignancies or during cell differentiation we have investigated the expression of the dbl oncogene in a wide number of human tumors of different embryological derivation. We found that dbl is preferentially expressed in a few neoplastic histiotypes of neuroectodermal origin. The transcript size of 5.3 Kb strongly suggests that the gene is not truncated in these tumors. These data, together with the information that the proto-oncogene has been found expressed in normal brain and adrenal medulla, indicate that dbl expression may be involved in cell differentiation of some tissues of neuroectodermic origin.

Gene Expression Regulation, Neoplastic↗
PubMed1984

Undifferentiated neuroectodermal tumors induced by human adenovirus type 31 in Syrian hamsters.

Human adenovirus type 31 was inoculated intraperitoneally into 18 and intracranially into 98 Syrian hamsters within 24 hours of birth. Intraperitoneal tumors developed multicentrically in 94.4%, 93 days on an average after virus inoculation, while brain tumors developed in 6.1%, 154 days. Intraperitoneal tumors primarily developed in the subserosal tissues and protruded into the peritoneal cavity. Some of the five enlarged brain tumors seemed to have extended from the paraventricular regions to the neighboring structures, and one microtumor was located in the subependymal layer. Twenty-six of the 98 hamsters inoculated with virus intracranially unexpectedly developed tumors in the subcutaneous tissue of the skull. Histological, immunohistochemical and electron microscopic studies revealed that the tumors which developed in the different sites had essentially the same features and were composed of undifferentiated small cells of primitive neuroectodermal nature. The incidence and the characteristics of the tumors were discussed in comparison with those of adenovirus type 12-induced tumors described previously.

Adenoviridae Infections↗
PubMed1986

The use of 131I-meta-iodobenzylguanidine in clinical diagnosis and staging of neuroectodermal tumors. Two case reports.

131I-Meta-iodobenzylguanidine has proved to be useful for the diagnosis of different kinds of neoplasms of neuroectodermal origin. The value of this scintigraphic method as a complementary technic to conventional diagnostic tests for staging in a child with neuroblastoma is described. In another child an ontogenetically related tumor, a mediastinal ganglioneuroma, was also visualized.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Deferoxamine and human neuroblastoma and primitive neuroectodermal tumor cell lines.

Deferoxamine at concentrations of 3.28 microM to 32.8 microM for five days causes in vitro growth inhibitory and cytolytic activities in human neuroblastoma and neuroectodermal cell lines. These effects are most likely due to intracellular iron depletion and vary with each cell line tested. A 3.28 microM threshold for cytolytic effects was observed in the most sensitive cell lines SK-N-DZ and SK-PN-LI, while proportionate responses ranging from lysis to relative growth inhibition was observed in the more refractory VA-N-BR, SK-N-LO and SK-N-AS cell lines. Cytolytic effects may represent an artifact of the in vitro setting where maximum exposure of cells to the drug can be achieved. Different sensitivities to deferoxamine in controlled in vitro conditions suggest variable anti-tumor effects can be expected in the clinical setting. Deferoxamine in patients may require a maximum tolerated dosage as a constant infusion for greater than 72 hours.

Cell Division↗
PubMed1991

Immunohistochemical characterization of primitive neuroectodermal tumors and their possible relationship to the stepwise ontogenetic development of the central nervous system. 1. Ontogenetic studies.

Aim of the present study was to establish different immunohistochemical staining patterns for a subsequent comparison with those of primitive neuroectodermal (PNET) subsets, i.e. PNET-NOS (not otherwise specified) or PNET with focal neuronal, astrocytic or ependymal differentiation, to relate neoplastic to embryonal development. Tissue of the developing central nervous system, with special emphasis on the stepwise development of the rhombencephalon, the cerebellar and the retinal anlage, from 20 different human embryos and fetuses ranging from 3 to 30 weeks of gestational age (GA) was examined. Six neuronal markers, synaptophysin, chromogranin A, neuron-specific enolase (NSE), neurofilament protein (NFP; 160 kDa, 200 kDa, 70 and 200 kDa) and six other markers, glial fibrillary acidic protein (GFAP), S-100 protein, vimentin, myoglobin, desmin, cytokeratin, were assessed immunohistochemically. GFAP and S-100 protein appeared at the 6th week of GA in primitive glial cells of the cerebellar anlage, brain stem, rhombencephalon, and developing spinal cord, together with--as first neuronal marker--chromogranin A, then NFP (70 and 200 kDa, and 160 kDa) from the 8th week onward. NSE started in the 11th week and synaptophysin not earlier than the 16th week of GA. Interestingly, the differentiation of the retinal anlage started rather late with NSE positivity beginning from the 16th week and positive reactions to synaptophysin and NFPs only from the 25th and chromogranin A from the 28th week of GA onward.

Central Nervous System↗
PubMed1990

[Ewing's sarcoma and peripheral neuroectodermal tumors. Report of a case with laterothoracic localization].

The authors report the case of a 20-year old male patient presenting with a lateral thoracic tumour which at pathological examination looked like an extra-osseous Ewing's sarcoma. Strongly positive NSE immunolabeling suggested a recently described variant of this lesion: Askin's tumour. In 1979, F. B. Askin described a tumour made of round small cells, located on the side of the thorax and possibly derived from differentiated neuroectodermal tissue. Since that time, the ever wider use of electron microscopy and immunohistochemical methods has made it possible to demonstrate the existence of peripheral neuroectodermal tumours (PNETs) distinct from neuroblastomas. Askin's tumour being only, as it turned out, one of their clinical forms. Following a brief presentation of the clinical, pathological and therapeutic features of PNETs, the authors underline the great similarity between these tumours and Ewing's sarcoma. Owing to the successive discoveries of a cytogenetic abnormality common to these tumour--t(11;22)(q24;q12)--, of a similar expression of proto-oncogens and of identical neuroenzymatic characteristics, Ewing's syndrome can now be regarded as the most undifferentiated of all PNETs, probably arising from the postganglionic neuron of the parasympathetic system.

Adult↗
PubMed1985

Phenotyping of 60 cultured human gliomas and 34 other neuroectodermal tumors by means of monoclonal antibodies against glioma, melanoma and HLA-DR antigens.

The reactivity spectrum of three monoclonal antibodies (Mabs) to human malignant glioma, five Mabs to melanomas and one Mab anti-HLA-DR was investigated by an indirect antibody binding radioimmunoassay on a panel of cells derived from 60 glioma lines, including 47 malignant astrocytomas, 11 low-grade astrocytomas and two malignant ependymomas as well on cells from 12 melanoma, three neuroblastoma, three medulloblastoma, two schwannoma, two retinoblastoma, two choroïd plexus papilloma, ten meningioma and 12 unrelated tumor lines. The anti-glioma Mabs BF7 and GE2 reacted preferentially with gliomas, while the anti-glioma Mab CG12 reacted with gliomas, melanomas, neuroblastomas and medulloblastomas. The five anti-melanoma Mabs reacted with gliomas, neuroblastomas and medulloblastomas. The anti-HLA-DR Mab D1-12 reacted with gliomas, melanomas and some meningiomas. On the basis of the data presented, we describe three different antigenic systems; the first one is glioma-associated, the second one is related to differentiation antigens expressed on cells derived from the neuroectoderm and the third is represented by HLA-DR antigens which are expressed not only on B-lymphoblastoid cells but also on melanomas and gliomas.

Antibodies, Monoclonal↗