Extraosseous Ewing's Sarcoma: Pictorial Review of Imaging Findings, Differential Diagnosis, and Pathologic Correlation

A rare case of calcified metastasis in a patient with primary osseous Ewing's sarcoma

We report an unusual case of an 11-year-old male with Ewing's sarcoma of the right fibula who presented 6 years post-remission with progressive dyspnea, fever, and swelling of the right ankle. Imaging revealed multiple partially calcified "cannonball" pulmonary metastases and a large, partially ossified, pleura-based mediastinal mass-an atypical metastatic presentation for this tumor. Histopathological confirmation was essential due to the diagnostic challenge posed by the calcifications, which are typically associated with infection or other malignancies. This case highlights the importance of considering atypical metastatic presentations in Ewing's sarcoma and emphasizes a multimodal diagnostic approach. The findings contribute to the sparse literature on calcified metastases in Ewing's sarcoma, calling for further research to understand the mechanisms and clinical significance of such presentations.

A 29-year-old woman with right lower lid mass

Extraosseous Ewing sarcoma is a rare entity mostly seen in the extremities and chest cavity in older individuals. Although osseous orbital Ewing sarcoma has been reported, extraosseous orbital involvement is extremely rare. We report the case of a young woman who presented with lower eyelid mass lesion. The results of histopathological and immunohistochemical analysis were suggestive of Ewing sarcoma. Radiological imaging and a PET-CT ruled out any bony orbital or systemic involvement. The patient was started on a standard chemotherapeutic protocol for Ewing sarcoma.

Extraskeletal Ewing Sarcoma Disguised as a Vascular Malformation

Extraskeletal Ewing sarcoma (EES) is a rare entity, accounting for only 3% of lesions encountered in upper extremity. We present two paediatric patients, who were initially diagnosed with a vascular malformation based on clinical assessment and imaging. Final histopathology revealed Ewing sarcoma of soft tissue origin, confirmed by immunohistochemical analysis. Hand surgeons, who are routinely approached for a myriad of hand pathologies, should be wary and consider EES as a differential when treating such lesions. A multidisciplinary approach with an appropriate treatment algorithm can help in a speedy diagnosis, improving the long-term prognosis of the disease. Level of Evidence: Level V (Therapeutic).

Extraosseous Ewing sarcoma in the fossa jugular: A rare case report

Background

Extraosseous Ewing sarcoma (EES) is a rare case that accounts for 20% of Ewing sarcoma cases. EES is the second most prevalent pediatric malignancy after peripheral primitive neuroectodermal tumors. EES mostly arise from soft tissue and extra-skeletal. Computed tomography (CT) and magnetic resonance imaging (MRI) are primary modalities for determining tumor location, characteristics, type, and extent of tumors. In addition, for presurgical management, radio intervention with arterial embolization is needed as a preoperative.

Case Description

We present a case of a 15-year-old boy diagnosed with EES. He had a "horn-like" tumor that grew progressively on his right ear over 5 months. Head CT scan and MRI were conducted to assess the extent. Embolization was performed before surgery. The surgery was conducted to excise the tumor radically. The histology pathology examination showed EES.

Conclusion

EES rarely occurs in the head and neck. This may manifest as a solid mass with bleeding components that destroy the nearby bones, with exophytic mass. Imaging is important for early finding and detecting complications of EES.

Paratesticular Ewing's sarcoma

This case report follows a 23-year-old man who presented with a painful right scrotal mass which was found to be a paratesticular vascular solid mass on ultrasound, and after uncomplicated orchiectomy, was revealed to be a high-grade extraskeletal Ewing's sarcoma. Diagnosis leading up to the orchiectomy was primarily clinical with only ultrasound used in identification and characterization of the paratesticular mass. Paratesticular masses are more commonly benign, and ultrasound is the first modality, with computed tomography and magnetic resonance imaging providing more definitive findings. We discuss imaging findings and histopathology of this rare tumor with an uncommon presentation.

EXTRASKELETAL EWING'S SARCOMA IN PEDIATRIC PATIENT RARE CASE: A CASE REPORT

This study reports a 12-year-old male was referred to our institute with a mass in the right ear. The mass was rapidly growing thus needing an immediate surgical attention. MRI revealed an exophytic, hyper vascular mass extending to the right jugular fossa and, the middle ear, and to the right acoustic meatus, suggestive of a right glomus jugulare tumor. Angiography showed a hypervascular lesion with robust feeding from the superficial temporal artery and right occipital artery. After surgery, the patient rapidly recover and he was discharged home on the 5th day after surgery. Three months after surgery, the lump reappeared and grew rapidly as before.