EWING’S SARCOMA

Traumatología y ortopedia

Overview

Introduction

Epidemiology

Clinical Presentation

Radiology

Pathology

Staging, Prognosis, Treatment

IntroductionIdentified in 1921 by James Ewing

Differed from osteogenic sarcoma

Different location

Poor survival: 5-10% at 5 years

Introduction

1967: radiation primarily

1969: adjuvant chemotherapy

More long term complications

EpidemiologyIncidence is 0.6 per million

Males > Females

65% in the 2nd decade of life

Rare in blacks and Asians

Clinical Presentation

History:

Pain most commonly (90%)

Swelling (70%)

Fever (20%)

Pathological fracture

Weight loss, malaise

Clinical PresentationPhysical Exam and Labs

Local warmth, inflammation

Pleural effusions

Neurological signs if spinal involvement

ESR, LDH, anemia, leukocytosis

RadiologySite

Size

Effect on bone

Response of Bone

Matrix

Cortex

Soft tissue

Pathology

Cell of origin is unknown

Previously a diagnosis of exclusion

Reciprocal translocation

PathologyGross: soft, tan, gray tissue

Micro: nests of small round cells

No osteoid or chondroid production

Surface cell glycoprotein

PathologyDifferential Diagnosis

Lymphoma

Osteomyelitis

OGS

EG

MFH

Metastatic neuroblastoma

Staging and PrognosisLocal and distal staging

Bone marrow aspirate

Pre-chemotherapy investigations

Biopsy

Staging and PrognosisLocation

Tumor Size

Metastases at diagnosis

Response to chemotherapy

TreatmentMultidisciplinary approach

Neoadjuvant chemotherapy, surgery

Don’t prolong interval between chemo

Radiation if indicated

Summary

Rare but common

Main ddx is lymphoma and infection

Large soft tisse masses

Neoadjuvant chemo and surgery

75-80% disease free survival at 5 years