Ewing’s sarcoma, named after pathologist James Ewing (1866-1943) is a malignant tumor developing from bone marrow. Ewing’s sarcoma can develop in any bone in the body, however, the most common area is in the pelvis and long tubular bones such as the femur of the lower extremity. Ewing’s is most commonly seen in people ages 10 – 20, however, children under 10 and adults over 20 are at risk. The risk drops significantly by age 30.
While Ewing’s sarcoma develops from bone marrow it can invade surrounding soft tissue. Therefore, it is not uncommon to develop a soft tissue mass around the area of involvement. Due to the destructive nature of Ewing’s sarcoma localized pain, usually for long durations, is a common complaint.
The radiographic appearance of Ewing’s sarcoma is most commonly an ill defined area of bone destruction involving a large central portion of the shaft. Periosteal reactions appear layered and are termed “onion skinned”. Due to the fact that Ewing’s sarcoma commonly involves the surrounding soft tissue, general radiography will typically not identify the extent of damage, therefore, MRI and CT are indicated. A Nuclear Medicine study such as PET will determine metastatic possibilities.
Treatment for Ewing’s sarcoma involves surgery to remove the primary lesion; if the tumor has invaded the majority of a long bone amputation is needed. Chemotherapy and radiation therapy are used to eliminate the cancer cells and halt metastatic activity. The survival rate for Ewing’s sarcoma has increased due to the advancements of modern chemotherapy.
Written by Chad Hensley M.Ed R.T. (R)(MR) UNLV Radiography Instructor
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