Desmoplastic small round cell tumor
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| ICD-O: | 8806/3 |
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[edit] Rare Sarcoma
Desmoplastic small round cell tumor is classified as a soft tissue sarcoma. It is an aggressive and rare tumor that primarily occurs as multiple masses in the abdomen. Other areas affected may include the lymph nodes, the lining of the abdomen, diaphragm, spleen, liver, lungs, testicles, ovaries, and the pelvis. The most common sites of metatastic spread is to the liver, lungs, and bones.
The tumor is considered a childhood cancer that predominantly strikes male adolescents and young adults. The disease rarely occurs in females, but when it does the tumors are often mistaken for Ovarian cancer.
[edit] Causes
There are no known risk factors that have been identified specific to the disease. The tumor appears to arise from the primitive cells of childhood, and is considered a childhood cancer.
Research has indicated that there is a chemeric relationship between desmoplastic small round cell tumor and Wilm's Tumor and Ewing's Sarcoma. DSRCT is associated with a unique chromosomal translocation (t11;22)(p13:q12) resulting in a EWS/WTI transcript that is diagnostic of this tumor. This transcript codes for a protein that acts as a transcriptional activator that fails to suppress tumor growth.
[edit] Symptoms
There are few early warning signs that a patient has a desmoplastic small round cell tumor. Patients are often young and healthy as the tumors grow and spread uninhibited within the abdominal cavity. These are rare tumors and symptoms are often misdiagnosed by family physicians. The abdominal masses can grow to enormous size before being noticed by the patient. The tumors can be felt as hard, round masses by palpating the abdomen.
First symptoms of the disease often include abdominal distention, abdominal mass, abdominal or back pain, gastrointestinal obstruction, lack of appetite, ascites, anemia, and/or cachexia.
Other reported symptoms include unknown lumps, thyroid conditions, hormonal conditions, blood clotting, kidney or urological problems, testicle, breast, uterine, vaginal, or ovarian masses.
[edit] Differentials
Because this is a rare tumor not many family physicians or oncologists are familiar with this disease. DSRCT in young patients can be mistaken for other abdominal tumors including rhabdomyosarcoma, neuroblastoma, and mesenteric carcinoid. In older patients DSRCT can resemble lymphoma, peritoneal mesothelioma, and peritoneal carcinomatosis. In males DSRCT may be mistaken for Germ Cell or testicular cancer. In females DSRCT can be mistaken for Ovarian cancer. Desmoplastic small round cell tumor shares characteristics with other small round cell cancers including Ewing's Sarcoma, Acute Leukemia, small cell Mesothelioma, Neuroblastoma, Primitive Neuroectodermal Tumor, Rhabdomyosarcoma, and Wilm's tumor.
[edit] Pathology
Pathology reveals well circumscribed solid tumor nodules within a dense desmoplastic stroma. Often areas of central necrosis are present. Tumor cells have hyperchromatic nuclei with increased nuclear/cytoplasmic ratio.
On immunohistochemistry, these cells have trilinear coexpression including the epithelial marker cytokeratin, the mesenchymal markers desmin and vimentin, and the neuronal marker neuron-specific enolase. Thus, although initially thought to be of mesothelial origin due to sites of presentation, it is now hypothesized to arise from a progenitor cell with multiphenotypic differentiation.
[edit] Treatment
This is an aggressive and fast spreading tumor and should be treated aggressively by a sarcoma specialist or oncologist familiar with the disease. Recent journals and studies have reported that some patients respond to high dose (P6) chemotherapy, debulking operation , and radiation therapy. Other treatment options include: Stem cell rescue, Intensity-Modulated Radiation Therapy, Radiofrequency ablation, Stereotactic Body radiation therapy, and Intraperitoneal hyperthermic chemoperfusion.
[edit] Prognosis
The prognosis for desmoplastic small round cell tumor remains poor with less than 20% surviving beyond two to three years. Prognosis often depends upon the stage of the cancer and the grade of the tumor. Because the disease can be misdiagnosed or remain undetected tumors frequently grow large within the abdomen and metastasized or seed to other parts of the body.
Indications are that a multi-modality approach of high dose chemotherapy, 90-100% surgical resection, radiation, and stem cell rescue improves survival for some patients.
[edit] Research
The Stehlin Foundation currently offers DSRCT patients the opportunity to send samples of their tumors free of charge for testing. Research scientists are growing the samples on nude mice and testing various chemical agents to find which are most effective against the individuals tumor.
[edit] Reference
Radiology:Desmoplastic Small Round Cell Tumor of the Abdomen: Radiologic-Histopathologic Correlation
Treatment of Desmoplastic Tumors at Mayo Clinic
Results of multimodal treatment for desmoplastic small round cell tumors
Desmoplastic Small Round Cell Tumor
CytoJournal:Desmoplastic small round cell tumour: Cytological and immunocytochemical features
Desmoplastic small round cell tumor with primary ovarian involvement: case report and review
[edit] Alternative Names
This disease is also known as: Desmoplastic small round blue cell tumor; Intraabdominal desmoplastic small round blue cell tumor; Desmoplastic small cell tumor; Desmoplastic sarcoma; DSRCT.
