Ewing's sarcoma of the cervix, a diagnostic dilemma: a case report and review of the literature.

INTRODUCTION: Ewing's sarcoma belongs to a spectrum of neoplastic diseases known as Ewing's family of tumors. This family of tumors is usually seen in osseous sites. Ewing's sarcoma of the cervix is extremely rare, with only 18 cases reported in the English literature. The immunohistochemical profile of Ewing's sarcoma overlaps with other malignancies like small cell carcinoma. The rarity and complex pathologic picture of Ewing's sarcoma of the cervix creates the potential for misdiagnosis. Hence, we believe this case needs to be reported to add to the available literature. CASE PRESENTATION: A 49-year-old white Caucasian woman presented with vaginal bleeding. A pelvic examination revealed a cystic lesion arising from her cervix. Examination of a biopsy specimen revealed a poorly differentiated neoplasm, with sheets of small hyperchromatic cells, staining weakly for neuroendocrine markers. She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation. However, additional positive immunostaining for CD99 was strongly suggestive of Ewing's sarcoma. Fluorescence in situ hybridization revealed ESWR1 gene rearrangement, confirming Ewing's sarcoma. Our patient underwent surgery, which confirmed stage IIB Ewing's sarcoma. She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles. CONCLUSION: With early diagnosis and appropriate treatment, Ewing's sarcoma of the cervix can be a potentially curable disease. However, owing to overlapping clinical and histopathological features, the diagnosis poses a challenge to oncologists and pathologists. This article guides pathologists to consider Ewing's sarcoma in the differential diagnosis of small cell carcinoma with weak staining for neuroendocrine markers. This literature review will benefit oncologists encountering this rare entity.

Malignant spinal cord compression.

Malignant spinal cord compression is one of the most dreaded complications of cancer. If untreated, it can lead to worsening neurologic function culminating in paralysis and sphincter incontinence. The most challenging aspect in the management of this complication is early diagnosis because the single most important factor determining outcome is the level of neurologic function at initiation of therapy. Magnetic resonance imaging is the diagnostic modality of choice. Steroids have a proven role in the treatment. Radiation therapy has been the standard of care, with surgery reserved for special cases. A recent randomized trial has proven that in appropriately selected patients initial surgery, followed by radiation, provides better functional and neurologic outcome compared to radiation alone and will likely become the standard of care in the future. Newer modalities, such as transarterial embolization and extracranial stereotactic radiosurgery, are emerging and may be considered in appropriate cases if available.

Emphysematous gastritis in a hemodialysis patient.

Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated systemic toxicity. We report a case of emphysematous gastritis in a 43-year-old diabetic patient receiving hemodialysis and review 41 cases published since 1889. The most common predisposing factors included ingestion of corrosive substances, alcohol abuse, abdominal surgery, diabetes, and immunosuppression. Diagnosis is based on clinical presentation of acute abdomen with associated features of systemic toxicity. The most commonly involved organisms were streptococci (nine cases), Escherichia coli (nine cases), Enterobacter species (six cases), Clostridium welchii (four cases), and Staphylococcus aureus (four cases). Computed tomography (CT) is the diagnostic procedure of choice. The mortality rate was 61% (25 of 41 patients). Gastric contractures after recovery were noted in 10% (4 of 41 patients). Antimicrobial therapy with antibiotics covering gram-negative organisms and anaerobes, and surgery in appropriate cases may enhance survival.

Intravascular lymphomatosis presenting as systemic inflammatory response syndrome.

Intravascular lymphomatosis is an unusual form of non-Hodgkin lymphoma characterized by intravascular proliferation of atypical lymphoid cells in multiple organs. It can cause systemic inflammatory response syndrome due to primary release of cytokines by the tumor cells or secondary release of cytokines after vascular occlusion by the tumor cells. It is a potentially fatal condition, because multiorgan failure can ensue due to thrombotic vascular occlusion. This is a very rare condition and most cases are diagnosed post mortem. We present a case of systemic inflammatory response syndrome and subsequent death from multiorgan failure in a patient with intravascular lymphoma.