December 11, 2012

Pelvic Ewing's Sarcoma

A pelvic radiograph of a 5-year-old girl shows a large lytic lesion in the left iliac bone (arrows).
An axial FDG PET/CT image shows high metabolic activity of the mass involving the left iliac bone with soft tissue component and bone destruction. A coronal T2W MR image reveals an extensive soft tissue mass with necrotic areas and involvement of the adjacent musculature. 

Differential Diagnosis
  • Metastatic neuroblastoma. Given her age at five years old, this needs to be in differentials
  • Ewing's sarcoma
  • Telangiectatic osteosarcoma
  • Osteomyelitis. Great mimics of aggressive-looking bone tumor. Symptoms may overlap with round-cell tumor, including fever
This case: Ewing's sarcoma by tissue diagnosis (+ve PAS and vimentin).

Facts: Ewing's Sarcoma

  • Malignant round-cell tumors of the bone with neural cell origin
  • Tumors of children and young adults, most between 10-20 years old. Less than 2% occur in children less than 5 years old
  • Most common sites = femur >> pelvis
  • Pelvic Ewing's -- bad prognosis because there is no anatomic barrier to tumor spread, close proximity to viscera and neurovascular bundles, prone to recur

Bhagat S, Sharma H, Pillai DS, Jane MJ. Pelvic Ewing's sarcoma: a review from Swedish Bone Tumour Registry. J Orthop Surg 2008;16:333-8

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