Acute lymphoblastic leukemia arising after treatment of Ewing sarcoma was misdiagnosed as bone marrow metastasis of Ewing sarcoma

Abstract

Rationale:Both acute lymphoblastic leukemia (ALL) and Ewing sarcoma (ES) are small round cell tumors, and it is difficult to differential diagnose them because of overlapping clinical, radiographic, histologic, and immunophenotypic features.Patient's concerns:A 5-year-old boy was admitted to our hospital because of pains in his left leg without obvious inducement and lameness worsening with walking over a two 2-month period.Diagnoses:Based on the comprehensive analysis of radiography, magnetic resonance imaging (MRI), pathology biopsy and immunohistochemistry, the lesion was confirmed to be ES.Interventions:The patient received neoadjuvant chemotherapy with 2 cycles of VAC (vincristine 1 mg/m2, adriamycin 50 mg/m2, cyclophosphamide 800 mg/m2) and 2 cycles of IE (ifosfamide 1.2 g/m2, etoposide 70 mg/m2, mesna 1.2 g/m2) regimens.Outcomes:After 16 months, the results of routine blood tests showed reduced hemoglobin levels and decreased platelet counts. In addition, blast-like cells were found in a peripheral blood smear. All of the results suggested that the patient should undergo bone marrow aspiration and biopsy, which showed blast-like cells similar to that observed in cases of ES. Thus, a diagnosis of bone marrow metastasis of ES was established. However, when combined with immunohistochemistry data and medical history, the patient was eventually diagnosed as ALL arising after treatment of ES.Lessons:When there was an abnormality in peripheral blood, it was easily misdiagnosed as bone marrow metastasis of ES after ES patient received neoadjuvant chemotherapy. We should jointly analyze bone marrow aspiration smear, bone marrow biopsy, immunohistochemistry, analysis of the medical history, even cytogenetic and molecular analysis for differential diagnosis.

High Specificity of BCL11B and GLG1 for EWSR1-FLI1 and EWSR1-ERG Positive Ewing Sarcoma

“…From a morphological point of view, histopathological diagnosis of EwS has been notoriously difficult due to its highly undifferentiated small-round-cell phenotype being shared with a variety of differential diagnoses [19], such as neuroblastoma, rhabdomyosarcoma, lymphoblastic lymphoma, desmoplastic small round cell tumor (DSRCT), and round-cell liposarcoma [20][21][22][23][24][25].…”

Secondary Malignancies after Ewing Sarcoma—Epidemiological and Clinical Analysis of an International Trial Registry

“…Bhatia et al confirmed that the risk of AML and MDS increased during treatments with a combination of anthracyclines (doxorubicin) and alkylating agents (cyclophosphamide, ifosfamide), as well as an increased cumulative dose of ifosfamide, cyclophosphamide, and doxorubicin [ 18 ]. Although there are several case reports of the association between chemotherapy and SMNs, few studies such as Bhatia et al’s study have demonstrated a significant association between SMNs and the use of the latter chemotherapeutic agents [ 18 , 62 ]. It is also known that the use of G-CSF in combination with etoposide increases the risk of secondary leukemia [ 57 ].…”

A case report on non‐metastatic Ewing sarcoma of the lumbar spine in a young patient

“…[8][9][10] Radiographic evaluation of ES shows permeative and infiltrative destruction of the involved bone, accompanied by periosteal reaction, such as onion skin appearance and codman triangle, or calcified spicule. 11 In the primary vertebral ES, the division of the spine into non-sacral (cervical, dorsal, and lumbar) and sacral (sacral and coccygeal) is important because sacral ES is considered aggressive and less responsive to therapy. 2,12 On the same note, the primary non-sacral ES occurs in 0.9% of all cases.…”