Family of cancers with common biology and treatment:
Ewing sarcoma of bone
Extraskeletal Ewing sarcoma (arises in soft tissue adjacent to bone)
Peripheral neuroectodermal tumor (PNET) o...
Pain is most common symptom.
Pain is often attributed to minor injuries that are common in this age group.
Other presenting symptoms are as follows:
Palpable mass
Fever
Limp
Systemic sympto...
In addition to systemic treatment with chemotherapy, patients need local control treatment to the site of the primary tumor and metastases (if present) with surgery, radiatio...
5-year overall survival rate for all patients is ~60%.
Presence of metastases is the most important prognostic factor.
Estimated overall survival in those with metastatic disease a...
Grier HE, Krailo MD, Tarbell NJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing’s sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. ...
170.9 Malignant neoplasm of bone and articular cartilage, site unspecified
170.6 Malignant neoplasm of pelvic bones, sacrum, and coccyx
170.7 Malignant neoplasm of long bones of lower limb
195....
Q: At what time point is a child with Ewing sarcoma considered cured?
A: Most cases of recurrence in Ewing sarcoma occur within 2 years of initial diagnosis. However, late relapses beyond 5 years f...
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Cytology figure of osteosarcoma showing tumor cells including a multinucleated cell.
Osteosarcoma showing osteoid formation with cytologically malignant cells.
Higher power of osteosarcoma showing pleomorphic spindle cells and multinucleated cells with osteoid formation.
Figure 58.2. Increased bone density in the distal femur. In this patient, the anteroposterior radiograph shows the neoplasm more clearly.
FIG. 4.25. Ewing sarcoma. This 9-year-old boy had fever and cough for 5 days. A: The chest radiograph shows a large left pleural effusion. B: A close-up of his left 10th rib shows bone erosion owing to an Ewing sarcoma.
FIG. 4.25. Ewing sarcoma. This 9-year-old boy had fever and cough for 5 days. A: The chest radiograph shows a large left pleural effusion....
FIGURE 115.13. Radiograph of a 5-year-old girl with an osteosarcoma of the left femur showing an acute pathologic fracture <italic>(arrows).</bold> Amputation was ultimately necessary.
FIGURE 115.13. Radiograph of a 5-year-old girl with an osteosarcoma of the left femur showing an acute pathologic fracture <italic>(...
<bold>Fig B 7-3. Ewing's sarcoma.</bold> Diffuse permeative destruction involves virtually the entire radius.
<bold>Fig B 8-2. Ewing's sarcoma.</bold> Laminated periosteal reaction on one side of the bone and thin periosteal elevation (Codman's triangle) on the other.
<bold>Fig B 8-2. Ewing's sarcoma.</bold> Laminated periosteal reaction on one side of the bone and thin periosteal elevation (...
Figure 11-101 <bold>THE RADIOGRAPHIC APPEARANCE OF LYTIC VERSUS SCLEROTIC OSTEOSARCOMA. A. Lytic Presentation:Proximal Humerus.</bold> Note the focal lesion in the metaphysis of the proximal humerus, demonstrating mottled, permeative destruction. This appearance is characteristic of a lytic presentation in osteosarcoma. <bold>B. Sclerotic Presentation:Proximal Humerus.</bold> Note the dense radiopaque appearance to the humeral head and its metaphysis. A large soft tissue mass and spiculated periosteal ...
Figure 11-101 <bold>THE RADIOGRAPHIC APPEARANCE OF LYTIC VERSUS SCLEROTIC OSTEOSARCOMA. A. Lytic Presentation:Proximal Humerus.</...
Figure 11-128 <bold>EWING'S SARCOMA: DIAPHYSEAL INVOLVEMENT. A. AP Ulna. B. Lateral Ulna.</bold> Observe the lytic destructive lesion in the diaphysis of the ulna. There is moderate expansion of the ulna noted. No charateristic periosteal response is present.
Figure 11-128 <bold>EWING'S SARCOMA: DIAPHYSEAL INVOLVEMENT. A. AP Ulna. B. Lateral Ulna.</bold> Observe the lytic destructive...
Figure 11-129 <bold>EWING'S SARCOMA: CORTICAL SAUCERIZATION AND ONION SKIN PERIOSTEAL RESPONSE. Femur.</bold> Observe the permeative destruction within the medullary portion of the mid-diaphysis of the femur. Disruption in the cortex, creating a saucerization appearance, is characteristic of Ewing's sarcoma (<italic>arrows</bold>). An additional radiographic sign of aggressive disease is the onion skin or laminated periosteal response seen adjacent to the cortical saucerization (<italic>arrowheads</bold>).
Figure 11-129 <bold>EWING'S SARCOMA: CORTICAL SAUCERIZATION AND ONION SKIN PERIOSTEAL RESPONSE. Femur.</bold> Observe the perm...
Figure 11-132 <bold>CHEST CANNONBALL METASTASES.</bold> Observe the multiple circular nodular metastatic lesions scattered throughout the central lung fields. These represent cannonball metastases, with sarcomatous growth within the lung parenchyma from Ewing's sarcoma of the femur.
Figure 11-132 <bold>CHEST CANNONBALL METASTASES.</bold> Observe the multiple circular nodular metastatic lesions scattered thr...
<bold>FIGURE 119.18</bold> Plain radiograph of the femur showing a high-grade osteosarcoma. The tumor is an ill-defined destructive lesion with an extensive soft tissue component. Codman's triangles are present (<italic>arrows</bold>).
<bold>FIGURE 119.18</bold> Plain radiograph of the femur showing a high-grade osteosarcoma. The tumor is an ill-defined destru...
<bold>Figure 11.54. Relationship of lesions to the physis. A,</bold> osteosarcoma extends down to the physis but does not cross it. <bold>B,</bold> tuberculous osteomyelitis has produced cystic lesions (*) on both sides of the physis. The ankle joint is still not crossed.
<bold>Figure 11.54. Relationship of lesions to the physis. A,</bold> osteosarcoma extends down to the physis but does not cros...
<bold>Figure 11.56.</bold> Laminated periosteal reaction. <bold>A.</bold> Drawing showing laminations (<italic>solid arrow</bold>). A Codman triangle is demonstrated on the opposite side (<italic>open arrow</bold>). <bold>B.</bold> Irregular interrupted periosteal reaction (<italic>arrows</bold>) in a patient with a Ewing tumor.
<bold>Figure 11.56.</bold> Laminated periosteal reaction. <bold>A.</bold> Drawing showing laminations (<italic...
<bold>FIGURE 26-43. Osteosarcoma.</bold> <bold>A.</bold> The distal femur contains a dense osteoblastic malignant tumor that extends through the cortex into the soft tissue and the epiphysis. <bold>B.</bold> A photomicrograph reveals pleomorphic malignant cells, tumor giant cells, and mitoses. The tumor produces woven bone that is focally calcified.
<bold>FIGURE 26-43. Osteosarcoma.</bold> <bold>A.</bold> The distal femur contains a dense osteoblastic malignant ...
<bold>FIGURE 26-46. Ewing sarcoma.</bold> <bold>A.</bold> A clinical x-ray demonstrates expansile cortical destruction with poor circumscription and a delicate interrupted periosteal reaction. <bold>B.</bold> A biopsy specimen shows fairly uniform small cells with round, dark blue nuclei, paucity of mitotic activity, and poorly defined cytoplasm. A periodic acid-Schiff (PAS) stain demonstrates abundant intracellular glycogen <bold><i>(inset)</i></bold>.
<bold>FIGURE 26-46. Ewing sarcoma.</bold> <bold>A.</bold> A clinical x-ray demonstrates expansile cortical destruc...
Figure 58.1. A destructive bone-forming lesion of the distal femoral metaphysis. Notice the destruction of the medial femoral condyle, the new bone formation in the region of bone destruction, and the elevation of the periosteum. These features are characteristic of osteosarcomas.
Figure 58.1. A destructive bone-forming lesion of the distal femoral metaphysis. Notice the destruction of the medial femoral condyle, the...
Osteosarcoma. (A) The distal femur contains a dense osteoblastic malignant tumor that extends through the cortex into the soft tissue and the epiphysis. (B) A photomicrograph reveals pleomorphic malignant cells, tumor giant cells, and mitoses. The tumor produces woven bone that is focally calcified.
Osteosarcoma. (A) The distal femur contains a dense osteoblastic malignant tumor that extends through the cortex into the soft tissue and t...
Ewing sarcoma. The tumor shows small, round cells, with glycogen-filled clear cytoplasm.