Ewing’s sarcoma

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  • 1. Ewing’s Sarcoma
  • 2. Overview• Introduction• Epidemiology• Clinical Presentation• Radiology• Pathology• Staging, Prognosis, Treatment
  • 3. Introduction• Identified in 1921 by James Ewing• Differed from osteogenic sarcoma• Different location• Poor survival: 5-10% at 5 years
  • 4. Introduction• 1967: radiation primarily• 1969: adjuvant chemotherapy• More long term complications
  • 5. Epidemiology• Incidence is 0.6 per million• Males > Females• 65% in the 2nd decade of life• Rare in blacks and Asians
  • 6. Clinical PresentationHistory:• Pain most commonly (90%)• Swelling (70%)• Fever (20%)• Pathological fracture• Weight loss, malaise
  • 7. Clinical PresentationPhysical Exam and Labs• Local warmth, inflammation• Pleural effusions• Neurological signs if spinal involvement• ESR, LDH, anemia, leukocytosis
  • 8. Radiology• Site• Size• Effect on bone• Response of Bone• Matrix• Cortex• Soft tissue
  • 9. Pathology• Cell of origin is unknown• Previously a diagnosis of exclusion• Reciprocal translocation
  • 10. Pathology• Gross: soft, tan, gray tissue• Micro: nests of small round cells• No osteoid or chondroid production• Surface cell glycoprotein
  • 11. PathologyDifferential Diagnosis• Lymphoma• Osteomyelitis• OGS• EG• MFH• Metastatic neuroblastoma
  • 12. Staging and Prognosis• Local and distal staging• Bone marrow aspirate• Pre-chemotherapy investigations• Biopsy
  • 13. Staging and Prognosis• Location• Tumor Size• Metastases at diagnosis• Response to chemotherapy
  • 14. Treatment• Multidisciplinary approach• Neoadjuvant chemotherapy, surgery• Don’t prolong interval between chemo• Radiation if indicated
  • 15. 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