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Metastatic Ewing cell sarcoma of the sinus and osteoid osteoma of the orbit
1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
Purpose:
To familiarize ophthalmologists with the management of a "solitary hot lesion" on bone scan as part of a metastatic examination.
Methods:
Case report of a 27-year-old man with primary Ewing sarcoma of the fibula. Bone scan as part of a metastatic evaluation showed increased uptake in the left orbit. A metastatic lesion could not be ruled out radiologically.
Results:
A biopsy was performed, and the lesion was found to be osteoid osteoma; therefore, the patient received only local radiation therapy to the fibula. Eight months later, the patient developed metastatic Ewing cell sarcoma of the sphenoid sinus and subsequently died.
Conclusions:
Because of the high sensitivity but low specificity of bone scan, secondary lesions on bone scan are not necessarily metastases. A biopsy specimen is often required for pathologic diagnosis.