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Image of the Month—Diagnosis
Arch Surg. 2008;143(5):512.
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Answer: Retroperitoneal Extraskeletal Ewing Sarcoma
A computed tomographic–guided fine-needle aspiration biopsy specimen obtained from the lesion revealed small and round blue cells with round nuclei, small nucleoli, and scanty cytoplasm, which seemed to be well organized. Immunohistochemical analysis revealed intense staining for CD99, CAM 5.2, epithelial membrane antigen, and anti–cytokeratin antibodies AE1/AE3, and negative staining for FLI-1, desmin, and leukocyte common antigen.
Based on these findings, the diagnosis was consistent with an extraskeletal Ewing sarcoma (EES) or primitive neuroectodermal tumor.
In accordance with the oncologists, the patient received 2 cycles of neoadjuvant chemotherapy according to the CEVAIE regimen (carboplatin, etoposide phosphate, vincristine, actynomicin D, ifosfamide, and epirubicine hydrochloride). On restaging magnetic resonance imaging, significant tumor shrinkage was reported, with a maximum diameter of the lesion of 7.5 cm; the tumor continued to infiltrate the left renal parenchyma, left renal vascular structures, and left adrenal gland and involved the pancreatic tail.
At laparotomy (Figure 2. . . [Full Text of this Article]
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Arch Surg. 2008;143(5):511.
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