Ewing's Sarcoma: A Case Report

Ewing’s sarcoma is a bone tumor, considered one of the most aggressive, for its great capacity of metastasizing. Higher incidence in men, appears almost exclusively in the first three decades of life. Affects the long bones in the metaphyseal region, at its proximal end; the most affected are the femur, iliac, tibia, humerus, fibula and ribs; however, there are atypical locations such as in the hands, feet and extraosseous. The clinical case of a 13‐year‐old male adolescent patient, who two months before his medical attention presented a mass at the level of the second and third right costal arches that increased vertiginously. After routine and laboratory examinations performed at a third level complexity hospital, he was diagnosed with Ewing's Sarcoma, where 3 chemotherapy sessions were performed; however, despite the treatment, he presented brain and bone metastases. Ewing's tumor was highly aggressive and has a bleak prognosis. Keywords: sarcoma, ewing, tomography, morbid metastasis. RESUMEN El Sarcoma de Ewing es un tumor óseo, considerado uno de los más agresivos, por su gran capacidad de metástasis. Tiene mayor incidencia en hombres, se presentan de forma casi exclusiva en las tres primeras décadas de vida, afecta a los huesos largos en la región metafisodiafisaria, en su extremo proximal, los más afectados son el fémur, el iliaco, la tibia, el humero, el peroné y las costillas. Sin embargo, existen localizaciones atípicas como en los pies manos y extraóseas. Se presentación el caso de un paciente adolescente masculino de 13 años, que dos meses antes de la atención médica presenta una masa a nivel de segundo y tercer arco costal derecho que aumenta de tamaño de forma vertiginosa. Posterior a exámenes de gabinete y laboratorio realizados en Hospital de Tercer Nivel de Complejidad, es diagnosticado de Sarcoma de Ewing en donde se realizan 3 sesiones de quimioterapia, sin embargo, pese el tratamiento presenta metástasis cerebrales y óseas, El tumor de Ewing es altamente agresivo y tiene un pronóstico sombrío Palabras claves: sarcoma de ewing, tomografía, metástasis mórbida.

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Ifosfamide-containing chemotherapy in Ewing's sarcoma: The Second United Kingdom Children's Cancer Study Group and the Medical Research Council Ewing's Tumor Study.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.11.3628 ◽

1998 ◽

Vol 16 (11) ◽

pp. 3628-3633 ◽

Cited By ~ 159

Author(s):

A Craft ◽

S Cotterill ◽

A Malcolm ◽

D Spooner ◽

R Grimer ◽

...

Keyword(s):

United Kingdom ◽

Survival Rate ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Study Group ◽

Primary Tumors ◽

Cancer Study ◽

Tumor Study ◽

Cancer Study Group ◽

Ewing’S Tumor

PURPOSE To investigate the possibility that the substitution of ifosfamide for cyclophosphamide therapy for Ewing's sarcoma will improve survival over that seen in the first United Kingdom Children's Cancer Study Group (UKCCSG) Ewing's tumor study (ET-1). PATIENTS AND METHODS Between 1987 and 1993,243 patients (138 men or boys) were entered onto the study. The median age was 13.5 years (range, 1.5 to 27 years). The median follow-up was 58 months. Chemotherapy included four courses of vincristine 2 mg/m2; ifosfamide 9 g/m2; and doxorubicin 60 mg/m2 administered every 3 weeks. Treatment of the primary tumor was with surgery and/or radiotherapy followed by ifosfamide 6 g/m2; doxorubicin 60 mg/m2; and vincristine 2 mg/m2; with actinomycin D 1.5 mg/m2 substituted for doxorubicin after a total dose of 420 mg/m2. RESULTS Two hundred one patients had no metastases. One hundred eighteen patients had tumors of the axial skeleton and 125 patients had limb primary tumors. The major toxicities were hematologic and infective, but there were no toxic deaths. The overall survival rate was 62% (95% confidence interval [CI], 56 to 69) and relapse-free survival (RFS) 56% (95% CI, 49 to 62). For those with no metastases at diagnosis, the RFS rate was 62% and for those with metastases, 23%. Multivariate analysis showed age and site to have a significant effect on RFS. Pelvic sites had the worst RFS rate of 41%; other axial sites, 55%; and extremity tumors, 73%. Age younger than 10 years had an RFS rate of 86% versus 55% for older patients. The local relapse rate for axial tumors was 20% and for limb primary tumors was 2.4%. CONCLUSION The 5-year survival rate of 62% is improved compared with the 44% survival rate achieved in ET-1. This is probably caused by the use of higher doses of ifosfamide compared with relatively low doses of cyclophosphamide in ET-1.

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THE MULTIDISCIPLINARY APPROACH IN A CASE OF PEDIATRIC EWING’S SARCOMA

Journal of Surgical Sciences ◽

10.33695/jss.v3i2.56 ◽

2016 ◽

Vol 3 (2) ◽

pp. 96-99

Author(s):

Ana-Maria Petrone ◽

Mădălina Macadon ◽

Gh. Burnei ◽

Ș. Gavriliu ◽

Raluca Ghiță

Keyword(s):

Multidisciplinary Approach ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Medical Attention ◽

X Rays ◽

Left Femur ◽

Undifferentiated Cells ◽

Sudden Appearance ◽

Inferior Limb

Ewing's Sarcoma is a rare, malignant osseous tumor arising from undifferentiated cells originating from the neural crest; however it may also develop in the soft tissue. The initial evaluation of a patient who is suspected to be suffering from Ewing's Sarcoma entails taking a thorough medical history along with performing a detailed physical examination. Our patient was diagnosed with Ewing's Sarcoma upon seeking medical attention due to the sudden appearance of pain in his left hip. The medical staff conducted a series of investigations including X-rays, MRI, CT and 3D-CT scans of the inferior limb and pelvis in order to yield the diagnosis of Ewing's Sarcoma; however, the definitive diagnosis was confirmed only by the biopsy performed before the surgery for modular endoprotesation. The patient received preoperative chemotherapy (in order to reduce the tumor dimension) according to the EuroEwing 2008 Protocol. After the seventh course of chemotherapy, surgery was performed, consisting of in-block resection of the proximal left femur and hip joint, followed by the insertion of a modular femoral endoprosthesis. Postoperative follow-up, however necessitated another six courses of chemotherapy.

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Prognostic Factors in Ewing’s Tumor of Bone: Analysis of 975 Patients From the European Intergroup Cooperative Ewing’s Sarcoma Study Group

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.17.3108 ◽

2000 ◽

Vol 18 (17) ◽

pp. 3108-3114 ◽

Cited By ~ 600

Author(s):

S.J. Cotterill ◽

S. Ahrens ◽

M. Paulussen ◽

H.F. Jürgens ◽

P.A. Voûte ◽

...

Keyword(s):

Prognostic Factors ◽

Bone Metastases ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Local Therapy ◽

Study Group ◽

Data Set ◽

Pädiatrische Onkologie ◽

Survival After Relapse ◽

Ewing’S Tumor

PURPOSE: To further elaborate on prognostic factors for Ewing’s sarcoma of bone and to document improvements in relapse-free survival (RFS) and trends in local therapy over the study period (1977 to 1993). PATIENTS AND METHODS: A retrospective analysis was performed on a combined Gesellschaft Für Pädiatrische Onkologie und Hämatologie/Cooperative Ewing Sarcoma Study and United Kingdom Children’s Cancer Study Group/Medical Research Council data set of 975 patients registered with the respective trial offices before the current collaborative European Intergroup Cooperative Ewing’s Sarcoma Study trial. Both groups independently undertook studies with similar chemotherapy during the period. RESULTS: The key adverse prognostic factor is metastases at diagnosis (5-year RFS, 22% of patients with metastases at diagnosis v 55% of patients without metastases at diagnosis; P < .0001). For the group with metastases, there was a trend for better survival for those with lung involvement compared with those with bone metastases or a combination of lung and bone metastases (P < .0001). In the group of patients with no metastases at diagnosis, multivariate analysis demonstrated that site (axial v other), age-group (< 15 v ≥ 15 years), and period of diagnosis had significant influence on RFS (all P < .005). RFS was superior in the period after 1985 compared with the period before 1985 for nonmetastatic patients (45% v 60%, respectively; P < .0001) and for metastatic patients (16% v 30%, respectively; P = .016). Patients who relapsed within 2 years of diagnosis had a less favorable prognosis than patients who relapsed later (5-year survival after relapse, 4% v 23%, respectively; P < .0001). There were other changes over the period; in particular, radiotherapy or amputation were more common in the period before 1986, whereas endoprosthetic surgery was widely used in the later period. CONCLUSION: Survival and RFS improved over the period. Prognostic factors are metastases at diagnosis, primary site, and age.

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Ewing’s Sarcoma of the Mandible-A Rare Case Report

JMS SKIMS ◽

10.33883/jms.v14i2.90 ◽

2011 ◽

Vol 14 (2) ◽

pp. 68-70

Author(s):

Shahid Hassan ◽

BH Sripathi Rao ◽

Gunachandra Rai

Keyword(s):

Rare Case ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Radiographic Examination ◽

Neural Tissues ◽

Rare Case Report ◽

Radiolucent Lesion ◽

Children And Young Adults ◽

Multiagent Chemotherapy ◽

Ewing’S Tumor

Ewing’s sarcoma is a malignant tumor of bones that primarily affects children and young adults. The true origin of this small round cell lesion still remains controversial.It was originally described by James Ewing in 1921 as arising from undifferentiated osseous mesenchymal cells, however, recent studies suggests that Ewing’s tumor might be neuroectodermally derived from various degrees of differentiation of the primitive neural tissues. This paper reports a rare case of ES of the mandible in a 11-year-old girl, which had been previously misdiagnosed and treated as a dental abscess. In the clinical examination, a hard immobile expansive mass of 2cm diameter was observed on the left side of the mandible. Radiographic examination revealed a diffuse radiolucent lesion with ill-defined borders and wide vestibular bone plate destruction. Microscopically, the tumor was composed by monotonous small round cells that exhibited immunoreactivity for CD99, vimentin and desmin. Surgical resection of mandible followed by mandibular reconstruction was adopted. The patient was subjected to multiagent chemotherapy with Vincristine [VC],Dactinomycin [AC],Cyclophosphamide [CP] and Doxorubicin [AD]). JMS 2011;14(2):68-70

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Acting child nursing care with osteosarcoma and Ewing's sarcoma: experience report / Agir cuidativo de enfermagem à criança com osteossarcoma e sarcoma de Ewing: relato de experiência / Actuacíon en el cuidado de la enfermería en niño con osteosarcoma...

Revista de Enfermagem da UFPI ◽

10.26694/reufpi.v4i4.3206 ◽

2015 ◽

Vol 4 (4) ◽

pp. 100

Author(s):

Kaio Vinícius Paiva Albarado ◽

Horácio Pires Medeiros ◽

Elizabeth Teixeira

Keyword(s):

Nursing Care ◽

Ewing’S Sarcoma ◽

Ewing's Sarcoma ◽

Experience Report ◽

Sarcoma De Ewing

Objetivos: Refletir sobre o agir cuidativo de enfermagem a um paciente portador de Osteossarcoma e Sarcoma de Ewing e indicar os diagnósticos de enfermagem e intervenções. Metodologia: Trata-se de um relato de experiência, com vistas a descrever um caso de um paciente infantil, tendo como base uma vivência. Estudo realizado com uma criança de 8 anos, internada em um hospital de Santarém-PA. Resultados: Os possíveis diagnósticos de enfermagem foram: Risco de infecção, Integridade tissular prejudicada, Ansiedade, Deambulação prejudicada e Mucosa oral prejudicada. Desse modo, as intervenções de enfermagem foram, respectivamente: Verificar a temperatura axilar a cada 20 minutos e comunicar ao profissional enfermeiro; realizar a troca de curativo do acesso venoso periférico a cada 48 horas; realizar a troca do curativo oclusivo no MIE uma vez ao dia; informar somente ao acompanhante do paciente a realização da troca do curativo oclusivo; incitar o paciente a movimentar o MIE, com exercícios de flexão e realizar a higiene bucal do paciente, após todas as refeições. Conclusão: Portanto, através dessa vivência, obtive melhor compreensão em como agir nos cuidados em paciente oncológico pediátrico.

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