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Ewing’s sarcoma
 

Ewing’s sarcoma

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    Ewing’s sarcoma Ewing’s sarcoma Presentation Transcript

    • Ewing’s Sarcoma
    • Overview• Introduction• Epidemiology• Clinical Presentation• Radiology• Pathology• Staging, Prognosis, Treatment
    • Introduction• Identified in 1921 by James Ewing• Differed from osteogenic sarcoma• Different location• Poor survival: 5-10% at 5 years
    • Introduction• 1967: radiation primarily• 1969: adjuvant chemotherapy• More long term complications
    • Epidemiology• Incidence is 0.6 per million• Males > Females• 65% in the 2nd decade of life• Rare in blacks and Asians
    • Clinical PresentationHistory:• Pain most commonly (90%)• Swelling (70%)• Fever (20%)• Pathological fracture• Weight loss, malaise
    • Clinical PresentationPhysical Exam and Labs• Local warmth, inflammation• Pleural effusions• Neurological signs if spinal involvement• ESR, LDH, anemia, leukocytosis
    • Radiology• Site• Size• Effect on bone• Response of Bone• Matrix• Cortex• Soft tissue
    • Pathology• Cell of origin is unknown• Previously a diagnosis of exclusion• Reciprocal translocation
    • Pathology• Gross: soft, tan, gray tissue• Micro: nests of small round cells• No osteoid or chondroid production• Surface cell glycoprotein
    • PathologyDifferential Diagnosis• Lymphoma• Osteomyelitis• OGS• EG• MFH• Metastatic neuroblastoma
    • Staging and Prognosis• Local and distal staging• Bone marrow aspirate• Pre-chemotherapy investigations• Biopsy
    • Staging and Prognosis• Location• Tumor Size• Metastases at diagnosis• Response to chemotherapy
    • Treatment• Multidisciplinary approach• Neoadjuvant chemotherapy, surgery• Don’t prolong interval between chemo• Radiation if indicated
    • Summary• Rare but common• Main ddx is lymphoma and infection• Large soft tisse masses• Neoadjuvant chemo and surgery• 75-80% disease free survival at 5 years