Age / Sex : 10 / M

Chief complaint: Right thigh pain for a month

What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Ewing's sarcoma

Discussion

•       Second m/c primary bone tumor of childhood after osteosarcoma

–      악성 골 종양중 6-10%

•       M>F

•       Age : 5 ~ 14 usually, under 30yrs              

•       Site : diaphysis of long bone  (femur)

                flat bones of the pelvis

–      Rare occurrence in the small bones of the hand and the feet

•       In 30%, multicentric in origin

•       In 14-50% , multiple metastases are present at the time of diagnosis

•       Plain radiography

•       - Permeative (76%)

•       - Laminated (onion skin) periosteal reaction(57%)

•       - Sclerosis (40%)

•       MRI

•       - T1: low to intermediate signal, T1 C+ (Gd): heterogeneous but prominent enhancement

•       - T2: heterogeneously high signal, may see hair on end low signal striations

•       Tx: Multidrug chemotherapy, Enblock excision of the tumor, Postop. Radiation

•        Prognosis factor

       : presence of distant metastases at diagnosis

          early metastasis to lung and bone