Imaging-based diagnosis for extraskeletal Ewing sarcoma in pediatrics: A case report.

Area of Science:

• Oncology
• Pediatric Oncology
• Radiology

Background:

• Extraskeletal Ewing sarcoma (EES) is a rare small, round, blue cell tumor affecting soft tissues.
• EES accounts for 15-25% of Ewing sarcoma family tumors, typically in young patients, with a poor prognosis.

Observation:

• A 7-year-old presented with a 5-month history of dyspnea and a 33x27x28 mm deep neck mass.
• Initial labs were normal. Ultrasound revealed a complex, solid-fluid mass with defined margins and posterior acoustic enhancement.
• Contrast-enhanced MRI showed significant early arterial phase enhancement, suggesting high vascularity.

Findings:

• The imaging characteristics, particularly rapid growth and enhancement, were indicative of a malignant process.
• Despite well-defined margins on ultrasound, the mass's rapid growth in a pediatric patient raised suspicion for malignancy.

Implications:

• This case underscores the importance of considering malignancy in pediatric patients with rapidly enlarging neck masses, regardless of imaging margin characteristics.
• Advanced imaging like MRI is crucial for characterizing deep neck masses and guiding diagnosis in pediatric oncology.