Temporary airway stenting as a bridge to chemotherapy in primary mediastinal Ewing's sarcoma with critical tracheal...

Primary mediastinal Ewing sarcoma is an exceptionally rare and aggressive malignancy that may rapidly lead to life-threatening compression of mediastinal structures. Management is particularly challenging when critical airway obstruction is present.

A 38-year-old woman presented with progressive dyspnea and cough. Chest imaging revealed a large right paratracheal mediastinal mass causing severe extrinsic tracheal compression with near-complete airway narrowing. Diagnosis was established by EBUS-TBNA, and histopathological and immunohistochemical findings were consistent with Ewing sarcoma. Given the imminent risk of respiratory failure, diagnostic EBUS-TBNA and airway stenting were performed during the same procedural session under general anesthesia. A fully covered self-expanding metallic stent was placed to secure the airway and enable safe initiation of systemic chemotherapy. The patient subsequently received VAC/IE chemotherapy. Follow-up imaging demonstrated marked tumor regression, and the stent was successfully removed after three months. At 6-month follow-up, the patient remained asymptomatic without clinical or radiological evidence of recurrence.

Temporary tracheal stenting may serve as an effective bridge to definitive therapy in selected patients with mediastinal Ewing's sarcoma and critical airway obstruction. Multidisciplinary management is essential in such high-risk cases.