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Case Reports
. 2020 Jul 2;99(27):e20859.
doi: 10.1097/MD.0000000000020859.

Primary vaginal Ewing sarcoma with uterine fibroid: A case report

Maolin Xu  1 , Yulin Liu  1 , Shue Zeng  2 , Hongbin Wang  3 , Gaolong Weng  2 , Fang Li  2
Affiliations
Case Reports

Primary vaginal Ewing sarcoma with uterine fibroid: A case report

Maolin Xu et al. Medicine (Baltimore). .

Abstract

Rationale: Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported.

Patient concerns: The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size.

Diagnosis: Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall.

Interventions: The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy.

Outcomes: The patient recovered well without local recurrence for >1 year.

Lessons: Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
MR examination of the pelvis. (A) Sagittal T2-weighted image showed a 7.5 × 4.9 cm solid and cystic mass with obscure margin (black arrow) and a 6.7 × 4.8 cm smooth, well-defined mass (white arrow). (B) Sagittal T1-weighted-enhanced image showed that the uterine tumor appears as heterogeneous enhancement, in the posterior uterine wall. (C) Axial T1-weighted-enhanced image showed that the vaginal tumor's edge appears as marked enhancement, in the ischiorectal fossa adjacent to the right lateral vaginal wall. (D) Axial diffusion-weighted image and (E) apparent diffusion coefficient image showed that the vaginal tumor's edge appears as restricted diffusion (black and white arrow).
Figure 2
Figure 2
US examination of the pelvis. (A) Color Doppler showed a 6.72 × 4.66 cm hypoechoic or anechoic mass, with no obvious blood flow signal. (B) Color Doppler showed a 6.26 × 5.00 cm well-defined heterogeneous hypoechoic mass in the medial aspect of posterior uterine wall, with a little blood flow signal in peripheral of mass. (C) Transvaginal ultrasound-guided puncture biopsy from vaginal mass. US = ultrasonography.
Figure 3
Figure 3
Pathologic image of biopsy from the vaginal mass (HE × 200). Small round-cells were uniform in size, with infiltration and extensive necrosis. HE = hematoxylin and eosin.
Figure 4
Figure 4
Histopathological and immunohistochemical (IHC) images of vaginal ES. (A) High power (400 × ) HE stain showed small cells with focal necrosis and mitotic activity. (B) Immunohistochemical findings presented positive expression of CD99 in the vaginal tumor cells (IHC × 400). ES = Ewing sarcoma, HE = hematoxylin and eosin.
Figure 5
Figure 5
Postoperative pathologic image of the uterine fibroid (HE × 100). HE = hematoxylin and eosin.
See this image and copyright information in PMC

References

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