Ewing’s Sarcoma of Ilium, Presenting as Right Lower Quadrant Pain

Abstract

Ewing's sarcoma is a highly malignant tumor of bone and is more common in children in the age group of 10 to 20 years. Sometimes the classic clinical and radiological presentation of Ewing's sarcoma may not be the norm and patient may have an atypical presentation leading to diagnostic confusion. This situation is especially true for Ewing's sarcoma involving iliac bone. We report a case of Ewing's sarcoma involving the right ilium in a patient presenting with right lower quadrant pain and nonspecific radiological changes. To the best of our knowledge, this scenario has not been reported in literature. We recommend early magnetic resonance imaging and computed tomography to diagnose the disease early when there is slightest suspicion of the disease.

Sarcoma de Ewing pélvico: o grande imitador

“…Fever, weight loss, anemia and increased inflammatory markers are uncommon unspecific manifestations. 1 7 8 Radiographs feature lytic destruction and subperiosteal bone formation similar to “onion skinning.” 1 4 5 8 These features are most easily detected in long bones in comparison with the pelvis. The value of radiographs in the pelvis is compromised by the anatomy of the iliac bone and of overlying structures.…”

“…The value of radiographs in the pelvis is compromised by the anatomy of the iliac bone and of overlying structures. 1 8 Computed tomography (CT) allows a better assessment of bone destruction and may show a soft tissue component. 1 5 Early magnetic resonance imaging (MRI) for soft tissue characterization and, to a lesser extent, identification of a “sharp transition zone”, is useful.…”

“… 3 7 These nonspecific clinical and imagiological findings may be present in conditions such as metastatic carcinoma, malignant lymphoma, osteomyelitis, 4 fibrous dysplasia 5 or eosinophilic granuloma (EG), 9 making its early diagnosis challenging. 1 2 3 4 5 6 7 8 9 The definitive diagnosis is made by open biopsy and histological examination combined with immunochemistry and cytogenetics. 1 4 The lack or insufficiency of histologic specimens by percutaneous biopsy may lead to its misdiagnosis.…”

“…Febre, perda de peso, anemia e aumento de marcadores inflamatórios são manifestações inespecíficas incomuns. 1 7 8 Radiografias apresentam destruição lítica e formação óssea subperiosteal semelhante a "esfolar cebola". 1 4 5 8 Essas características são mais facilmente detectadas em ossos longos em comparação com a pelve.…”

“… 1 7 8 Radiografias apresentam destruição lítica e formação óssea subperiosteal semelhante a "esfolar cebola". 1 4 5 8 Essas características são mais facilmente detectadas em ossos longos em comparação com a pelve. O valor das radiografias na pélvis é comprometido pela anatomia do osso ilílico e de estruturas de estruturas sobrejacentes.…”