|Patient: 12 year old female|
|History: 12-year-old female with a right-sided pelvic mass.|
RADIOPHARMACEUTICAL: 6.1 mCi F-18 Fluorodeoxyglucose i.v.
|DDx: Ewing's sarcoma|
|Diagnosis: Ewing's sarcoma of the right iliac bone.|
General Discussion: Long history: 12-year-old female who presented with right leg pain,|
and this developed into a limp which was progressively symptomatic. She had
an associated 20-pound weight loss, more recently developed inability to
urinate. An MRI revealed a 3 cm pelvic mass centered around the right iliac bone.
Discussion: Ewing sarcoma, a highly malignant primary bone tumor, was first described by James Ewing in 1921. The tumor is derived from red bone marrow. Most frequently, it is observed in children and adolescents aged 4-15 years and rarely develops in adults older than 30 years. Ewing sarcoma accounts for approximately 5% of biopsy-analyzed bone tumors and approximately one third of primary bone tumors. Ewing sarcoma is the second most common malignant bone tumor in young patients, and it is the most lethal bone tumor. Males are affected more frequently than females, with a ratio of approximately 1.5:1. Ewing sarcoma occurs in African Americans and Asians. An association exists between Ewing sarcoma and primitive peripheral neuroectodermal tumor. Most frequently, the tumor is diagnosed as a monostotic lesion in the metaphysis or diaphysis of the long bones of the extremities. The tumor also may occur, although less frequently, in the pelvic area, ribs, and scapulae. In fact, any bone may be involved.
Whole-body bone scan can provide information about the primary lesion and depict skip lesions. Also, bone scintigraphy can be used to localize distant metastases during tumor staging.
PET/CT is significantly more accurate than PET alone for the detection and localization of lesions and improves staging for patients with Ewing tumor. The hybrid technique is superior to PET alone in terms of sensitivity, specificity, and accuracy, mainly because of the detection of new lesions. FDG-PET also is useful following therapy, and it can reveal early changes in tumor metabolism, which is an indicator of the therapeutic effect. Bone marrow scanning is of limited use because of the availability of MRI.
|References: Völker T, Denecke T, Steffen I, Misch D, Schönberger S, Plotkin M, Ruf J, Furth C, Stöver B, Hautzel H, Henze G, Amthauer H. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. |
J Clin Oncol. 2007 Dec 1;25(34):5435-41.
Gerth HU, Juergens KU, Dirksen U, Gerss J, Schober O, Franzius C. Significant benefit of multimodal imaging: PET/CT compared with PET alone in staging and follow-up of patients with Ewing tumors. J Nucl Med. 2007 Dec;48(12):1932-9.
Hawkins DS, Schuetze SM, Butrynski JE, Rajendran JG, Vernon CB, Conrad EU 3rd, Eary JF.[18F]Fluorodeoxyglucose positron emission tomography predicts outcome for Ewing sarcoma family of tumors. J Clin Oncol. 2005 Dec 1;23(34):8828-34.
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Case Number: 98319Owner(s): Farrokh Dehdashti and Xiaoni HongLast Updated: 12-15-2010 The reader is fully responsible for confirming the accuracy of this content.
The reader is fully responsible for confirming the accuracy of this content.