21yo male with localized Ewing sarcoma of the femur... and o | Figure 1

fel-x
Orthopedic Surgery

21yo male with localized Ewing sarcoma of the femur... and one incidental finding

This young man was diagnosed with Ewing sarcoma of the right femur after several months of progressive thigh pain and swelling.

The X-ray shows cortical involvement, but looks deceptively mild compared with the MRI. The soft-tissue extension into the quadriceps is massive, and PET-CT reveals it to be the most metabolically active component - the ideal target for biopsy. Fortunately, no metastatic lesions were identified.

A percutaneous core needle biopsy was performed by the radiologist using a coaxial trocar system, following careful planning with the MSK oncology team to ensure that the biopsy tract could be excised en bloc at the time of definitive tumor resection.

Histopathology confirmed Ewing sarcoma, and the patient was started on chemotherapy according to the Euro-Ewing 2012 protocol.

In the follow-up post, I’ll discuss how to define the surgical target volume (whether it should be based on the initial or post-chemotherapy extent of the tumor) and show intraoperative images of the chosen reconstruction technique.

Any suggestions on which reconstruction method you would favor?

Bonus challenge: there’s an incidental finding on the PET-CT ... kudos to anyone who spots it! I’ll share a better image and details in a follow-up post as well.

Diagnosis added by author
Localized Ewing sarcoma of the femur (+ incidental finding on another bone)

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