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

Reference:
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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