PMC9399424_01
Comparison of the magnetic resonance images of the tumor at the coronal, sagittal, and axial plane before and after rupture. (A), (C) and (E) tumor at 20 weeks (before rupture) was shown. (B), (D) and (F) tumor at 22 weeks (after rupture) was shown.
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F1
Bimanual pelvic examination revealed the tumor was in the cervix, without invading the vagina, or adjacent organs (Figure 1).
(A,B) Microscopic view of the tumor of the cervix with H&E staining, revealing that tumors were composed of a monotonous population of small round cells. IHC staining was positive for (C) CD99, (D) FLI-1, (E) Ki-67, and (F) p16. Magnification details: (A) x100; (B)200x; (C) 200x; (D) 400x; (E) 200x; and (F) 200x.
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F2
Ki-67 proliferation index was about 80% (Figure 2).
(A) FISH testing demonstrated that more than 35% of cells were positive indicating EWS-FLI1 gene rearrangement (FLI1 gene, red; EWSR1 gene, green; and EWS-FLI1 fusion gene, yellow). (B)Fusion of EWS -exon 7 to FLI1-exon 6 (ews-7/fli1-6) creates a PCR product of 100 bp, while fusion of EWS -exon 7 to FLI1-exon 5 (ews-7/fli1-5) creates a PCR product of 166 bp. (C)Investigation of the EWS-FLI1 fusion transcripts in this patient. The primers (EWS- and FLI1-) were used in subsequent PCR reactions of RT-PCR assays performed on RNA isolated from paraffin-embedded tumor tissue to search for fusion transcripts with different exon combinations (EWS-exon 7 fused to either FLI1-exon 5 or -exon 6). The patient's sample was found positive for a EWS-FLI1 product at the 166bp. S: sample; N: normal cervix tissue; L: 100bp DNA ladder.
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F3
FISH demonstrated that more than 35% of the cells were positive, indicating the presence of the EWS-FLI1 fusion gene (Figure 3A). The results showed the RT-PCR product of the tumor was 166bp, which indicated that the 7th exon of EWS was fused to the 5th exon of FLI1 (Figures 3B,C).