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.

A Novel Two-Step Technique for Retrieving Fractured Peripherally Inserted Central Catheter Segments Migrating into the Heart or the Pulmonary Artery

Objective. To report the experience of a percutaneous technique for retrieving fractured peripherally inserted central catheter (PICC) segments migrating into the heart or the pulmonary artery.Method. From April 2013 to July 2015, we performed percutaneous retrieval of fractured PICC segments migrating into the heart or the pulmonary artery in five cancer patients who had undergone chemotherapy via PICC. The fractures were diagnosed with chest plain radiography. The patients included three cases of breast cancer, one case of rectal cancer, and one case of lower limb Ewing’s tumor. The fractures were retained in the vessels of the patients for 1 to 3 days. All the fractures were retrieved by using a novel two-step technique in the digital subtraction angiography (DSA) suite. This two-step technique involves inserting a pigtail catheter to the heart or the pulmonary artery to grasp the fractured catheter fragment and bring it to the lower segment of the inferior vena cava, followed by grasping and removing the catheter fragment with a retrieval loop system of the vena cava filter retrieval set.Result. The fractured PICC segments were removed successfully in all five patients via unilateral (four patients) or bilateral (one patient) femoral vein access. No complications occurred during the interventional procedure.Conclusion. Percutaneous retrieval can be a safe, convenient, and minimally invasive method for the removal of fractured PICC segments. The technique reported in this paper will be applicable for the retrieval of fractured PICC segments and other catheter fragments migrating into the heart or the pulmonary artery.

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

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