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Pelvic Ewing Sarcoma: The Great Mimicker.

Francisco Lima-Bernardes1, Diogo Manuel Soares1, Joana Monteiro Pereira1

  • 1Ortopedista e Traumatologista, Departamento de Ortopedia e Traumatologia, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.

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Summary

Ewing sarcoma of the pelvis can mimic benign conditions in children and young adults, complicating diagnosis. Definitive diagnosis relies on advanced techniques beyond initial biopsies.

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anti-onflammatory agents, non-steroidaleosinophilic granulomaosteomyelitispelvic neoplasmssarcoma, Ewing

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Area of Science:

  • Pediatric Oncology
  • Skeletal Radiology
  • Surgical Pathology

Background:

  • Ewing sarcoma is a primary bone malignancy prevalent in pediatric and young adult populations.
  • Pelvic Ewing sarcoma presents challenges due to its potential to mimic non-malignant bone pathologies.
  • Aggressive treatment protocols are associated with poor survival rates for this cancer.

Purpose of the Study:

  • To highlight diagnostic challenges in pelvic Ewing sarcoma.
  • To present cases where Ewing sarcoma mimicked eosinophilic granuloma and osteomyelitis.
  • To emphasize the importance of advanced diagnostic methods when initial biopsies are inconclusive.

Main Methods:

  • Case report analysis of two pediatric patients with pelvic Ewing sarcoma.
  • Clinical, imaging, and histopathological review of presented cases.
  • Evaluation of diagnostic utility of percutaneous bone biopsy, immunochemistry, and cytogenetics.

Main Results:

  • Both cases demonstrated atypical presentations, simulating benign entities like eosinophilic granuloma and osteomyelitis.
  • One case showed an initial, misleading response to antibiotic and anti-inflammatory therapy.
  • Percutaneous bone biopsies yielded inconclusive results in both instances.

Conclusions:

  • Pelvic Ewing sarcoma requires a high index of suspicion due to its varied presentations.
  • Immunochemistry and cytogenetics are crucial for accurate diagnosis, especially when initial biopsies are equivocal.
  • Overlooking Ewing sarcoma can lead to delayed treatment and poorer outcomes.