Ewing's Sarcoma- A review.

Hello everybody!

Let's review a few important points on Ewing's sarcoma.

Ewing sarcoma is one of the small, round cell lesions of bone

Second most common malignant bone tumor in children (after osteosarcoma)
Common in males than females.

Occurs between the ages of 5-30 years.

 Location:

Arise in medullary cavity, usually of long bones in the lower extremities. Commonly involves metadiaphysis of long bones.

Most commonly occurs in long bones and pelvis but they can occur in virtually any bone.

Clinical Findings:

Most common symptoms are localized pain and swelling.

Additional symptoms:

Fever

Weight loss

Anemia

Leukocytosis

Elevated erythrocyte sedimentation rate 

Imaging Findings:

Most lesions are visible on conventional radiographs

However, their degree of spread is better evaluated with MRI

Common manifestations on conventional radiography include

1)Poorly marginated, lytic, destructive lesion

2)Permeative (small holes) or moth-eaten (mottled) appearance

3)Rarely, they can be sclerotic,Soft tissue mass or infiltration is common

4)Soft tissue mass may occur without destruction of cortex.Soft tissue mass may produce saucerization (scalloped depression in cortex)

5)Periosteal reaction is common

6)Lamellated - onion-skinning due to successive layers of periosteal development

7)Sunburst or spiculated - hair-on-end appearance when new bone is laid down perpendicular to cortex along Sharpey’s fibers.

8)Codman’s triangle - formed between elevated periosteum with central destruction of cortex

9)Osteosclerosis may be present secondary to reactive bone formation

Prognosis:60-75% five-year survival.

Treatment:Systemic chemotherapy is the mainstay of treatment with surgery and/or radiotherapy playing a role depending of the location and size of the tumour.

Hope this was useful.

Let's Learn Together!

-Medha.