Ewing Sarcoma: The Diagnostic Dilemma
- QUEZON CITY FEU-NRMF AUGUST 2016
- 14 PAGES
ABSTRACT: Ewing sarcoma (ES) is the second most common primary malignant pediatric bone neoplasm, [1] however, cranial occurrence is extremely rare. [2] The following is a discussion about such a case in 4 year-old child who presented with right ptosis, headache, visual disturbance and eye movement abnormality initially suspected to be a case of meningioma. Prompt diagnosis and treatment is crucial in ES because once metastasis is detected, poor prognosis follows with survival rate of only up to 30%. In this case, ES may have been overlooked at the onset of the investigation of the patient's condition because 1) her clinical presentation was nonspecific for intracranial tumors with mass effect, 2) MRI and CT findings were not the most typical for this malignancy and 3) biopsy findings were vaguely congruent with meningioma, which was the primary consideration early on. However, since the morphology of the excised tumor was still not the most typical for meningioma, it is prudent to consider other differentials and probe further Immunohistochemical staining was thus done and showed results diffusely positive for CD99 and synaptophysin, and focally positive for vimentin, leading to the diagnosis of ES. With a diagnosis of ES, the treatment widely accepted is a comprehensive multidisciplinary approach of surgery, chemotherapy and radiotheraphy. [1]For this specific case, the patient underwent surgical removal of the tumor and is currently undergoing chemotherapy. However there was no plan for radiotheraphy. ES is thus a rare disease which may present similarly to other intracranial masses. Correlation between the cinical, radiologic and histopathologic findings, including tissue immunochemical analysis, is a crucial to its diagnosis. There are treatment options available today for this malignancy, but we must be prudent in weighing the pros and consto determine the best approach for the patient.