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EWING'S SARCOMA
Authored By: tdeshm01 and Keith Fischer.
Patient: 8 year old female
History: 8-year-old girl with left arm pain for a few weeks.
Image Size:[small][as-submitted]

Fig. 1
Bone Scintigraphy

Fig. 2
Bone Scintigraphy

Fig. 3
Radiograph of left humerus

Fig. 4
Radiograph of left humerus (post-surgery)

Fig. 5
Bone scintigraphy (One year post surgery and chemotherapy)

Fig. 6
Bone scintigraphy (One year post surgery and chemotherapy)

Fig. 7
Follow up bone scintigraphy - 9 months after prior exam

Fig. 8
Follow up bone scintigraphy - 9 months after prior exam

Fig. 9
Left arm radiograph - New fracture through mid-portion of fibular graft. Internally-fixated proximal humeral fibular graft fracture.
Image Size:[small][as-submitted]

Findings:

Bone scintigraphy: There is marked diffuse increased uptake throughout the humeral diaphysis which appears moderately expanded. Differential diagnosis includes a primary neoplasm and osteomyelitis.

 

 Radiograph of left humerus: There is a permeative, lytic lesion involving the diaphysis of the left humerus with associated aggessive periosteal reaction and a wide zone of transition. Differential considerations include Ewing's sarcoma, PNET, lymphoma, and somewhat less likely osteomyelitis or Langerhans cell histiocytosis.

 

Surgical pathology: Ewing's sarcoma

 

IMAGING POST-SURGERY:

 

Radiograph of left arm: Resection of the humerus from the proximal to distal metaphyses. A fibular bone graft spans this gap. Numerous surgical staples and a surgical drain are in place.

 

Bone scintigraphy (One year post surgery and chemotherapy): Stress reactions within the tibia bilaterally likely secondary to prior right fibular graft harvesting. No evidence of recurrent tumor or metastases.

 

Follow up bone scintigraphy - 9 months after prior exam: Focal increased uptake involving the midportion of the fibular graft in the left upper arm.

DDx:

 

1. Fracture through fibular graft

 

2. Recurrent tumor

Diagnosis: Fracture through the mid-portion of the left arm fibular graft.
General Discussion:

Ewing's sarcoma usually causes high uptake in the affected bone. Some aggressive lesions appear as areas of low uptake. Skeletal tracer localization in the soft tissue component of a Ewing's sarcoma is occasionally observed.

 

The primary role of skeletal scintigraphy in Ewing's sarcoma is to detect skeletal metastases which typically appear as focally high uptake. A flare response may occur in skeletal metastases of patients treated with chemotherapy.

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Additional Details:

Case Number: 233930Owner(s): tdeshm01 and Keith FischerLast Updated: 02-07-2013
Anatomy: Skeletal System   Pathology: Neoplasm
Modality: Conventional Radiograph, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: bsnm

Case has been viewed 32 times.
Certified by Keith Fischer on 09-03-2010

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