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Cytodiagnosis of retroperitoneal primitive neuroectodermal tumour (PNET)--a case report.

A rare case of Retroperitoneal Primitive Neuro Ectodermal Tumour (PNET) in thirty years old female is presented. Fine needle aspiration cytology (FNAC) characterised by small round cells with scanty cytoplasm, poorly to well formed rosettes with neurofibrillary background; whereas periodic acid-schiff (PAS) rarely react with Primitive Neuro Ectodermal Tumour (PNET), prompted the diagnosis of PNET at cytology itself. Cytological appearances of PNET have been reviewed and the various differential diagnoses are discussed.

Adult↗

Birth characteristics and brain cancers in young children.

BACKGROUND: High birthweight is a potential risk factor for childhood brain tumours, particularly astrocytomas. We investigated several birth characteristics in relationship to brain cancers in young children. METHODS: We obtained 849 invasive central nervous system (CNS) cancer cases, ages 0-4 years, from California's population-based cancer registry for 1988-1997. We matched 746 (88%) of these cases to a California live birth certificate. We randomly selected two control birth certificates for each case, matched on date of birth and gender. We used conditional logistic regression to obtain odds ratios (OR) and 95% CI. The birth characteristics examined included birthweight, gestational age, race, parental age, and parental education. RESULTS: Analysing all CNS tumours combined, we found that children of other racial/ ethnic groups had OR below one compared with non-Hispanic white children. When adjusted for gestational age, race/ethnicity, and mother's place of birth, the OR for high birthweight (>/=4000 g) was 1.05 (95% CI: 0.79-1.38) compared with children with birthweights of 2500-3999 g. For astrocytomas (313 cases), the adjusted OR for high birthweight was 1.40 (95% CI: 0.90-2.18). When parental education was included in the model (available for only a subset of the birth years), the adjusted OR was 1.71 (95% CI: 1.01-2.90). High birthweight did not appear to be a risk factor for primitive neuroectodermal tumours (PNET). CONCLUSIONS: We found high birthweight associated with increased risk of astrocytomas, but not PNET, in young children.

Astrocytoma↗

Congenital primitive neuroectodermal tumour presenting as obstructed labour.

Brain tumours presenting at delivery are extremely rare. A case of primitive neuroectodermal tumour (PNET) that presented intrapartum with failure to progress due to hydrocephalus is reported. Diagnosis required imaging with magnetic resonance and computed tomography in addition to open biopsy.

Brain Neoplasms↗

Microdissection genotyping of mixed glial and primitive neuroectodermal central nervous system neoplasm.

A 22-year-old man with previous radiation treatment for childhood astrocytoma underwent resection of a right parietooccipital lesion. Histopathology revealed a malignant neoplasm with areas of astrocytic and primitive neuroectodermal components. To resolve the relationship and cellular origin, representative tissue was microdissected from several targets, obtaining a balanced mixture of each element. Nonneoplastic brain parenchyma was separately microdissected to determine polymorphic marker informativeness and to serve as an internal negative control. Despite the relatively small quantity of tissue removed for each microdissection target, sufficient material was available for reliable, balanced, polymerase chain reaction-format genotyping encompassing a panel of tumor suppressor genes and genetic loci associated with these forms of neoplasia. The findings revealed distinct discordant genotypic profiles for each of the neoplastic components. The efficacy of the approach used for molecular analysis of this complex neoplasm and the implication of the genotypic findings are discussed.

Adult↗

Experimental induction of primitive neuro-ectodermal tumours in rats: a re-appraisement of the ENU-model of neurocarcinogenesis.

A series of 122 experimental brain tumours, induced in the Wistar rat by means of prenatal exposition to ethyl-nitrosourea, were studied with histological, immunohistochemical and ultrastructural techniques. Although with conventional histological techniques, most of the induced tumours showed morphological features suggesting their classification as malignant schwannomas or oligodendroglioma-like neoplasms, their study by means of immunohistochemistry and electron microscopy suggested that they are, in fact, primitive neuroectodermal tumours, with a tendency toward neuronal differentiation. This finding obliges us to re-appraise the ethyl-nitrosourea model of neurocarcinogenesis and to consider its possible usefulness for the experimental study of therapeutic approaches with potential applications in human neuro-ectodermal neoplasms.

Animals↗

Ovarian primary primitive neurectodermal tumor coexisting with endometrioid adenocarcinoma: a case report.

We report an unusual case of a 78-year-old woman with primary ovarian tumor that consisted of primitive neurectodermal tumor and endometrioid adenocarcinoma. The patient presented with abdominal pain and weight loss and had disseminated disease at her initial presentation. She was treated with debulking surgery followed by chemotherapy. The patient was still asymptomatic at the 6-month follow-up.

Aged↗

Primary Ewing's sarcoma/primitive neuroectodermal tumor of the kidney: a clinicopathologic and immunohistochemical analysis of 11 cases.

Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) is an extraordinarily rare primary tumor in the kidney and can be mistaken for a variety of other round cell tumors, including blastema-predominant Wilms' tumor (WT). Approximately 90% of ES/PNET have a specific t(11;22), which results in a chimeric EWS-FLI-1 protein. Immunohistochemistry for the carboxy-terminus of FLI-1 is sensitive and highly specific for the diagnosis of ES/PNET. WT-1, the WT-associated tumor suppressor gene, is overexpressed in WT but not in ES/PNET. No study has examined FLI-1 or WT-1 expression in renal ES/PNET. The clinicopathologic features of 11 renal ES/PNET were studied along with immunohistochemistry for cytokeratin, desmin, CD99, FLI-1, and WT-1. WT were also immunostained for CD99 (5 cases), FLI-1 (10 cases), and WT-1 (9 cases). The patients (6 men, 5 women) ranged from 18 to 49 years of age (mean, 34 yr). The mean tumor size was 11.8 +/- 3.8 cm (mean +/- standard deviation). Presenting symptoms included abdominal/flank pain and/or hematuria. Grossly, all tumors showed necrosis and hemorrhage, and 4 had cystic change. Microscopically, all tumors showed vaguely lobular growth, primitive round cells, and variable rosette formation. Epithelial, myogenous, or cartilaginous differentiation was not seen. Immunohistochemical results on the renal ES/PNET were cytokeratin (2/8 focal), desmin (0/9), CD99 (8/8), FLI-1 (5/8), and WT-1 (0/8). In comparison, the WT only rarely expressed CD99 (1/5) and did not express FLI-1 (0/10), but were usually WT-1-positive (7/9). Follow-up on 8 cases (mean, 28 mo; range, 6-64 mo) showed 4 lung and pleural metastases, 1 bone metastasis, liver metastasis, 2 local recurrences, and 5 deaths from disease (median time to death, 16.8 mo). No case had distant metastatic disease at presentation. Adjuvant therapy included chemotherapy (8 cases), radiation (3 cases), and bone marrow transplantation (1 case). Our study affirms a unique proclivity of renal ES/PNET for young adults and that it is a highly aggressive neoplasm, with rapid death in many cases, usually after the development of treatment-resistant lung metastases. These tumors must be distinguished from blastema-predominant WT and other primitive renal tumors that require different therapy. FLI-1 and WT-1 immunohistochemistry may be valuable in this differential diagnosis, given the known immunophenotypic overlap between ES/PNET and blastema-predominant WT with regard to CD99, cytokeratin, and desmin. The accurate distinction between these two entities has clear prognostic and therapeutic implications.

12E7 Antigen↗

Malignant medulloepithelioma of the optic nerve in a horse.

An 18-month-old Standardbred filly had a large intraocular tumor involving the optic nerve. The tumor was a malignant medulloepithelioma, a rare intraocular neoplasm derived from the primitive medullary epithelium. By light microscopy the tumor had cords and lobules of primitive neuroepithelial cells that formed clefts and true rosettes. Electron microscopy of the rosettes showed a girdle of zonulae adherentes joining the apices of the cells as well as several basal bodies. This is the sixth report of equine intraocular medulloepithelioma, and, to the best of our knowledge, the first intraocular medulloepithelioma arising from the optic nerve head in a horse. Massive involvement of the optic nerve should be suspected when an eye containing an intraocular mass in the posterior segment lacks light perception. In such cases a long segment of opitc nerve should be resected.

Animals↗

Diagnosis of Ewing's sarcoma and related tumours by detection of chromosome 22q12 translocations using fluorescence in situ hybridization on tumour touch imprints.

It is increasingly recognized that the identification of t(11;22)(q24;q12) is a useful aid in the accurate diagnosis of Ewing's sarcoma and related tumours. However, cytogenetic studies have a low success rate and adequate tumour is not always available. This study describes the use of fluorescence in situ hybridization (FISH) to detect translocations at 22q12, the site of the EWS gene involved in t(11;22)(q24;q12), on tumour touch imprints made from true cut core-needle biopsy and frozen tumour. Of the seven tumours analysed, five diagnosed as Ewing's sarcoma or primitive neuroectodermal tumour demonstrated chromosome translocation at 22q12. This is a rapid and reliable method to detect a diagnostically relevant chromosome translocation using minimal amounts of fresh or frozen tumour.

Adolescent↗

Chromosomal rearrangement t(11;22) in extraskeletal Ewing's sarcoma and primitive neuroectodermal tumour analysed by fluorescence in situ hybridization using paraffin-embedded tissue.

The clonal chromosomal rearrangement t(11;22) has been reported by karyotypic analysis to be specific for Ewing's sarcoma of bone and soft tissue origin as well as primitive neuroectodermal tumour. In this report, immunohistological analysis of MIC 2 expression and fluorescence in situ hybridization (FISH) were performed using paraffin-embedded tissues. We examined t(11;22) in the nuclei isolated from two Ewing's sarcomas, four primitive neuroectodermal tumours, and three neuroblastomas, which served as negative controls by FISH with an alpha-satellite DNA probe for chromosome 11, a chromosome 22 marker probe, and whole chromosome painting probes for both chromosomes 11 and 22. Both cases of Ewing's sarcoma and the four primitive neuroectodermal tumour specimens were immunoreactive for MIC 2. Both Ewing's sarcomas and three of the four primitive neuroectodermal tumours contained the tumour-specific t(11;22), but the three neuroblastomas did not show this translocation. Based on the cytogenetic results and on the immunohistological investigation of MIC 2 expression, Ewing's sarcoma is suggested to be related closely to primitive neuroectodermal tumour. FISH is a useful aid in determining the tumour type of Ewing's sarcoma and putative related tumours.

12E7 Antigen↗

Peripheral primitive neuroectodermal tumour of the kidney: CT findings.

Peripheral primitive neuroectodermal tumour in the kidney is a rare entity with high malignant potential. The distinctive demographic, clinical and radiological findings, as described in the present case, should suggest this aggressive tumour in the differential diagnosis of renal neoplasms in adolescents.

Adolescent↗

An experimental mouse testicular teratoma as a model for neuroepithelial neoplasia and differentiation. II. Electron microscopy.

The electron microscopic features of the stages of divergent neuroepithelial differentiation in the solid implants of a transplantable mouse testicular teratoma (OTT-6050) are presented and compared to the sequential stages of cytogenesis that have been described in the developing avian and mammalian central nervous system. Primitive neuroepithelial tumor cells showed the features of undifferentiated multipotential matrix (or ventricular) cells of the neural tube. They formed primitive medullary rosettes, from which various transitions were traced to more differentiated, cilia-containing ependymoblastomatous rosettes; the transitional features included increased granular endoplasmic reticulum and microvilli formation. Glial differentiation was characterized by the presence of mature ependymal rosettes and of astrocytes containing glial filaments. Neuronal differentiation included the development of synapses and the presence of dense-core vesicles in nerve cell processes. No intermediate cell forms were found that suggested multiple lines of differentiation occurring within a single cell.

Animals↗

Expression of the neuronal form of pp60c-src in neuroblastoma in relation to clinical stage and prognosis.

The expression of the protooncogene c-src has been studied in specimens of childhood tumors with special reference to neuroblastoma and other tumors of neuronal origin. For comparison c-src gene expression was studied in seven neuroblastoma and neuroepithelioma cell lines. The structurally distinct neuronal product of the gene, pp60c-srN, expressed during normal development in neuroblasts and neurons, was identified by immunoblotting technique together with the fibroblast form, pp60c-src. While pp60c-src was found in most tumors studied, the neuronal form was restricted to neuroblastomas (23 of 27) and retinoblastomas (3 of 3) and could not be detected in the other childhood tumors. A dominance of the neuronal form, pp60c-srcN, was exclusively found in the infant cases of neuroblastoma (9 of 12), estimated to have good prognosis. These results indicate that pp60c-srcN might be a diagnostic marker in primitive childhood tumors. When expressed in higher amounts than pp60c-src, pp60c-srcN may be a positive prognostic marker in neuroblastoma, especially useful in the evaluation of infants. In addition, lack of pp60c-srcN seems to be incompatible with low stage neuroblastoma.

Aging↗

Local recurrence and distant metastasis of supratentorial primitive neuro-ectodermal tumor in an adult patient successfully treated with intensive induction chemotherapy and maintenance temozolomide.

Supratentorial primitive neuro-ectodermal tumors (PNET) in adults are very rare. Extraneural metastasis are unusual and the optimal palliative chemotherapy regimen is not established. We present a 26-year-old patient with local recurrence and distant metastasis of supratentorial PNET successfully treated with intensive induction chemotherapy and maintenance temozolomide.

Adult↗

Peripheral primitive neuroectodermal tumour of the cervix.

Peripheral primitive neuro-ectodermal tumours (PNET) of the cervix are very rare. Here, we report the clinical, pathological, immunohistochemical and genetic features of a case of a PNET located in the cervix. Hysterectomy revealed a cervical tumour. On microscopic examination, a vaguely lobular arrangement of uniformly appearing neoplastic cells, with round to oval nuclei, distinct nuclear membranes and a clear, moderately glycogen-rich cytoplasm was seen. Cells stained positive for LEU 7, S 100, monoclonal NSE and particularly for MIC2. Neurogenic differentiation was also seen by electron microscopic examination. The genetic hallmark of PNET, a 22q12 rearrangement was demonstrated by fluorescence in situ hybridisation experiments, supporting the diagnosis. Awareness of the existence of primary PNET of the cervix is important to avoid confusion with other tumours of the cervix.

Biomarkers, Tumor↗

ILK (beta1-integrin-linked protein kinase): a novel immunohistochemical marker for Ewing's sarcoma and primitive neuroectodermal tumour.

ILK (beta1-integrin-linked protein kinase) is a recently identified 59-kDa serine/threonine protein kinase that interacts with the cytoplasmic domain of the beta1-integrin containing four ankyrin-like repeats. We have developed a polyclonal antibody against ILK and explored the ILK immunoreactivity in normal human cells and tissues. ILK was mainly expressed in cardiac muscle and skeletal muscles. Surprisingly, ILK expression was observed in Ewing's sarcoma (ES; 100%), primitive neuroectodermal tumour (PNET; 100%), medulloblastoma (100%), and neuroblastoma (33.3%), whereas other small round cell sarcomas were not stained by the anti-ILK antibody. These results suggest that ILK could be a novel marker for tumours with primitive neural differentiation. Our findings support the notion that ES is a tumour that is closely related to PNET and that both originate from the neuroectoderm. ILK may be a sensitive and specific immunohistochemical marker and useful for the positive identification of ES and PNET in formalin-fixed, paraffin-embedded tissue sections.

Adolescent↗

The association of embryonal tumors originating in the kidney and in the brain. A report of seven cases.

This report documents, in seven infants younger than 2 years of age, a previously unrecognized association of a renal embryonal neoplasm (malignant rhabdoid tumor in six patients and a Wilms' tumor in one) with an embryonal primary tumor originating in the central nervous system. The neuroepithelial tumors included three cerebellar medulloblastomas, one pineoblastoma, one primitive neuroepithelial tumor (probably cerebral neuroblastoma), one malignant subependymal giant cell astrocytoma, and one cerebellar medulloepithelioma with divergent glial and neuronal differentiation. There is no evidence that this association is based on the selective neoplastic transformation of embryonal cells of similar histogenetic or cytogenetic origin. The relationship between these dissimilar, embryologically unrelated tumors remains enigmatic.

Astrocytoma↗