Extra-osseous Ewing sarcoma of the pancreas: case report with radiologic, pathologic, and molecular correlation, and brief review of the literature.

In 2002, due to extensive histomorphologic, immunohistochemical, and cytogenetic similarities, the World Health Organization unified undifferentiated small round blue cell neoplasms of soft tissue and bone (previously segregated as Ewing sarcoma or Primitive Neuroectodermal tumor) into one category: Ewing family of tumors (EFT). Osseous EFT are more common, and while extra-osseous EFT can occur anywhere in the body, those of the pancreas are rare and likely to be seen in the second decade of life in the head of the pancreas. We report the case of a 39-year-old Caucasian male with a large heterogeneously enhancing mass in the pancreatic body. Pathologic examination showed a malignant round blue cell tumor diffusely positive for CD99, chromogranin, and synaptophysin; Ki-67 proliferation index was greater than 80%. FISH showed EWSR1 gene rearrangement in 90% of cells and Archer FusionPlexTM-targeted RNA sequencing analysis identified the EWSR1-FLI1 fusion transcript. The diagnosis of EFT of the pancreas was rendered. Unfortunately, the patient had minimal improvement and was transitioned to oral pain medications to continue care at a different institution.

The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpretation Errors: A Pilot Study.

PURPOSE: The purpose of the study was to determine if increasing radiologist reading speed results in more misses and interpretation errors. METHODS: We selected a sample set of 53 abdomen-pelvis CT scans of variable complexity performed at a teaching hospital during the study period. We classified the CT scans into 4 categories based on their level of difficulty, with level 4 representing the most-complex cases. Five attending radiologists participated in the study. We initially established an average baseline reporting time for each radiologist. Radiologists were randomly assigned a set of 12 studies, of varying complexity, to dictate at their normal speed, and a separate set of 12 studies, of similar complexity, to read at a speed that was twice as fast as their normal speed. The major and minor misses were recorded and analyzed. A χ(2) analysis was used to compare the results. RESULTS: Reading at the faster speed resulted in more major misses for 4 of the 5 radiologists. The total number of major misses for the 5 radiologists, when they reported at the faster speed, was 16 of 60 reported cases, versus 6 of 60 reported cases at normal speed; P = .032. The average interpretation error rate of major misses among the 5 radiologists reporting at the faster speed was 26.6%, compared with 10% at normal speed. CONCLUSIONS: Our pilot study found a significant positive correlation between faster reading speed and the number of major misses and interpretation errors.

Case Report: Primary Leiomyosarcoma of the breast with unusual metastasis to the femur.

With less than 40 cases reported, primary leiomyosarcoma is an extremely rare form of breast cancer (less than 0.0006% of cases) with unpredictable biological behavior that usually presents as a slow growing, mobile mass in middle age women. Most cases are low-grade and are cured by complete excision with wide margins. After surgical resection, late local recurrence and distant hematogenous metastasis to lungs and liver is, however, well-documented. To the best of our knowledge, bone metastasis has never been reported. Here we present a case of primary leiomyosarcoma of the breast metastatic to the femur.