2. Definition
Group of highly aggressive malignant neoplasm
which are composed predominantly of small,
round and monotonous undifferentiated cells
with high
nuclear-cytoplasmic ratio.
3. Diagnostic Approach
Clinical Findings
Radiological Findings
Pathological Findings
Molecular Genetics
Immunohistochemical Features
Age
Sex
Site
Clinical presentations
Cytology Findings
Gross Findings
Light Microscopy
Electron microscopy
FISH Techniques.
RT PCR.
Flow Cytometry
6. Primitive Neuroectodermal Tumors
(Neural crest tumor)
Batsakis et al(1996)
CNS PNETs
Tumors derived
from the
central nervous system
Tumors derived from the
autonomic nervous system
Neuroblastoma
Tumors derived from
tissues outside the
central and
autonomic nervous system
Peripheral PNETs/
Ewing Family of tumors
Based on the tissue of origin
Ewing sarcoma Malignant peripheral PNETs Askin tumor *Other
*Neuroectodermal tumor, ectomesenchymoma, peripheral medulloepithelioma. These tumors were thought to arise directly from nerves.
7. Ewings Sarcoma/PNETAge:5-20 yrs
Sex:M>F
Site:
-Bone: Medulla of diaphysis or metaphysis of
femur, pelvis,
tibia,humerus, ribs and fibula.
-Soft tissue: Deep soft tissue of extremities
Presentations:
Bone: Clinically the tumor may simulate
osteomyelitis
Soft tissue: Rapidly growing, deeply located mass
measuring 5-10cm
in greatest diameter. Can cause
20. Molecular Genetics
Over 95% show reciprocal translocation of chromosome 11 : 22
(q24 : q 12).
This leads to fusion of EWS gene with FLI-1.
Detected by the
• RT-PCR
• Fluorescent in situ hybridization (FISH) technique
*in cytologic preparations, frozen sections, or paraffin sections.
26. Gross Findings
Of Retinoblastoma
Gross:May be flat and diffuse or elevated, and
may show multicentric foci of origin, especially
in the hereditary type.
Three patterns of growth are recognised :
1Endophytic:growth occurs
inwards into the vitreous.
Cell clusters may detach and
float in the vitreous
(vitreous seeding)
27. 2Exophytic
Growth occurs outwards
Grow between the retina and the pigment epithelium
Associated with non-rhegmatogeneous retinal detachm
3 Diffuse infiltrating growth
35. Immun0histochemical
Features
Specific markers of retinal differentiation
• Retinal-binding protein
• Retinal S-antigen
• Interphotoreceptor retinal-binding protein
• Cone opsin
• Rod opsin
• MLGAPC
37. Neuroblastoma
Age: Under 4 yrs (21 month)
Sex:M=F
Site: Retroperitoneum (70%), and the majority of these involve the
adrenal gland.
Other sites-along sympathetic chain, posterior mediastinum, neck,
brain
Presentations
• An abdominal mass first noted by the parents.
• Rarely watery diarrhea,Cushing syndrome,heterochromia iridis and
horner syndrome (in cervical or mediastinal tumors) and
opsoclonus/myoclonus
44. Immun0histochemical
Features
Reactivity for
• Neuron-specic enolase
• NB-84(anti neuroblastoma antibody)
• S-100
• Insulin-like growth factor 2
• Neurofilament
• Chromogranin
• Synaptophysin
• Secretogranin II
• Vasoactive intestinal peptide
• Microtubule-associated proteins
• Growth factor receptors, and other neural-related
antigens, including the cell surface ganglioside GD2.
45. Molecular Genetics
Amplification of the N-myc oncogene detected by FISH techniqu
Catecholamines demonstration in sections or touch preparations
formaldehyde-induced fluorescence technique.
Expression of genes involved in catecholamine biosynthesis can
with
the polymerase chain reaction (PCR) technique.
Trk receptor protein by Northern analysis and immunohistochem
46. Nephroblastoma
Age:Infants (primarily), less than 3 years ( 50%) & less than 6
years (90%)
Sex:M=F
Site: Kidney;
Presentations:Large abdominal mass
Hematuria
Pain in abdomen
Hypertension
Conditions associated with wilms’ tumor are
• WAGR syndrome
• Beckwith wiedemann Syndrome
• Denys Drash Syndrome
54. Immun0histochemical
Features
Reactivity for
• Vimentin
• Keratin
• Epithelial membrane antigen
• Myogenin
• Desmin
• Neuron specific enolase
• S-100
• Glial fibrillary acid protein
• WT-1(90%)
• CD56(96%)
• Type I insulin-like growth factor
Blastematous elements
Epithelial elements
Mesenchymal /Stromal
elements
Neural elements
55. Molecular GeneticsGenetic loci predisposing to wilms’
tumor are
• WT1 ( located on chromosome 11p 13
)
• WT2 ( located on chromosome
11p15.5)
• Mutations of B catenin gene-14-20%
56. Rhabdomyosarcoma
Age:
• Embryonal:3-12 yrs;
• Alveolar:10-25 yr
Sex:M>F
Site: Embryonal: Unsegmented and undifferentiated mesoderm
Common in the
- Head and neck region (particularly the orbit, nasopharynx, middle ear, and oral cavity),
- Retroperitoneum
-Urogenital tract
-Extremities
-Skin.
Alveolar:
• Mostly extremities (forearm, arm)
-Perirectal & perineal region
Presentations:
• Based on location.
• Usually manifests as an expanding mass.
• Hypercalcemia or with elevated parathormone levels in some cases.
74. Molecular Genetics
Translocation t(2;13) or t(1;13), which results in
the
gene fusions PAX3–FOXO1A and PAX7–
FOXO1A,
respectively.
Translocations can be detected in paraffin
embedded tissue with the FISH technique.
MYCN amplification in close alveolar
rhabdomyosarcomas.
99. Immun0histochemical
Features
Reactivity for
• Class III beta tubulin
• microtubule-associated protein 2
• Hu and NeuN
• TrkA and TrkC neurotrophin
receptors.
• Photoreceptor-associated proteins
-(rod-opsin and retinal S-antigen)
• Neurofilament
• Vimentin
• Desmin
• Myogenin
• NSE
102. PineoblastomaAge:Children and adolescents
Sex:M>F
Site:Parenchyma of pineal gland
Presentations:
• Obstructive hydrocephalus
• Parinaud syndrome
• CSF seeding in 15% of patients at the time of
diagnosis.
• Trilateral retinoblastoma
• Association with familial adenomatous colonic
polyposis as a possible variant of type 2 Turcot
syndrome.
111. Molecular Genetics
Most frequent rearrangement is that of
chromosome 1
RB1 gene on Chromosome 13 germline
deletion
DICER1 gene mutation
112. Hepatoblastoma
Age:. Primarily in infants, but isolated instances in older childr
Sex:M>F.
Site: Liver cells( Rt lobe)
Presentations:
• A large mass in the abdomen and swollen abdomen
• Decreased appetite and weight loss
• Vomiting
• Jaundice (yellowing of eyes and skin) and Itchy skin
• Anemia
• Back pain
• Virilization
113. Hepatoblastoma
Associated with a variety of congenital abnormalties
• Particularly hemihypertrophy
• Wilms tumor of kidney
• Glycogen storage disease
• Familial colonic polyposis.
124. Molecular Genetics
Trisomies 2, 8, and 20, and rearrangements of
1q.
CTNNB1 (β-catenin) gene.
CGH analysis :High frequency of X-chromosome
gains.
Evaluation of DNA content by flow cytometry.
125. Desmoplastic small round cell
tumor
Age:Adolescents and young adults
Sex:M>F
Site:Intra Abdominal: Pelvic region and sometimes the entire
tumor is limited to the paratesticular region
• Other sites:bone, kidney, lung, ovary, pancreas, pleura,
spermatic cord, uterus,
central nervous system, sinonasal region and salivary glands.
Presentation:Intra Abdominal:Characteristically presents as a
single mass or multiple nodules within the abdominal cavity.
• Accompanying ascites is the rule;
Association with Peutz–Jeghers syndrome
140. Lymphoblastic Lymphoma
Age:Primarily in children and adolescents, but it also occurs in
adults
Sex:M>F
Site: Mediastinum( Thymus).
Presentations:
• Typically presents with acute respiratory distress in teenager.
• Extremely aggressive, with rapid multisystem dissemination.
• Leukemic blood picture (acute lymphoblastic leukemia).
• Death after a few months.