| Images of Musculoskeletal Oncology |
| Ewing's Sarcoma |
| 21 year old man had hip pain and limp for a few months, thought to be from a soccer injury. |
| A pelvic x-ray revealed an osteolytic lesion in his ilium. The core needle biopsy revealed a small round blue cell neoplasm compatible with a diagnosis of Ewing’s Sarcoma. There were no obvious metatases. The chest x-ray was normal. | |
| Treatment included chemotherapy, radiation and partial internal hemi-pelvectomy. This post operative radiograph demonstrates that a great deal of the ilium has been removed. |
| Twelve years after surgery, he developed pulmonary metastases which were treated by surgical resection. He was given chemotherapy again. | |
| Now, nearly twenty years after first being seen, he is free of disease but does have increasing hip pain. |
| He does have 1.5 inches of shortening, positive Trendelenburg, and marked arthritis of his hip. He is being treated conservatively. |
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| Learning Issues: 1. Ewing’s Sarcoma patients must be monitored for many years. Chemotherapy is critical for long term survival. Radiation with hazards of its own (such as radiation produced sarcoma) and the value of surgical resection (wide resection instead of partial removal is recommended) is still being debated. In addition, the radiation as well as poor mechanics after surgery played a role in producing the hip arthritis. 2. The outcome in Ewings’s Sarcoma patients is certainly better today than it was in the days of early survival, when the only treatments used were radiation or amputation. |
| Images of Musculoskeletal Oncology |
| University at Buffalo Department of Orthopaedics |