Ewing’s sarcoma of the mandible: Radiologic features with emphasis on magnetic resonance appearance

Ewing's sarcoma of the mandible in a young child

“…This presentation is not specific, but it demands complementary exams that can avoid larger arrears in the diagnosis, which in the casuistry of Widhe and Widhe (11), occurred within 5 weeks on the average, harming the precocious diagnosis and leading to the risk of more aggressive approaches. Radiographically, ES appears as a poorly defined osteolytic lesion that may be frequently associated with cortical erosion and soft tissue mass adjacent to the destructive site (6,12). Although ES is most often seen presenting osteolytic change with bone destruction, this aspect is not a pathognomonic feature, as other lesions can have the same image pattern, such as neuroblastoma, osteogenic sarcoma, histiocytosis X, and osteomyelitis (5,13).…”

“…It exhibits a marked predilection for whites and is rarely seen among blacks (3). The majority of the patients affected are between the ages 5 and 20, whereas the disease is distinctly uncommon in individuals before age 5 and after age 30 (3,6).…”

“…The presence of sun-ray spicules of periosteal bone and displacement or destruction of unerupted tooth follicles have been described as the commonest radiological features for ES affecting jaw bones (7,13). Further, the presence of the laminar periosteal response (known as "onion skin" reaction), which some authors point out as a common radiological feature described for lots of ES of the long bones, is rarely seen in jaws lesions (6,14). In the present case, the radiographic finding was an osteolytic lesion associated with severe displacement of dental germ of the canine and punctual cortical erosion in the base of the mandible.…”

“…Although conventional radiography is still considered an useful method for determining the presence of bone lesions and, of course, an important imaging approach for suggesting ES, CT scan and magnetic resonance imaging have been currently stated by some authors as the best imaging methods for evaluating the full extent of the primary lesion into the soft tissue and bone invasion prior to the onset of therapy (3,6,14). In this case, the CT scan was made before treatment and revealed both the intraosseous origin of the tumor as well as the real extent of bone destruction of the mandible, which was accurately depicted with the threedimensional CT scan imaging method.…”

Ewing’s Sarcoma of Mandible: A Very Rare Disease and Review of Indian Literature

“…Ewing's Sarcoma HPE shows small, poorly differentiated cells with medium-size, round or oval nuclei exhibiting a fine chromatin pattern, small nucleoli and scanty cytoplasm [7]. The Intracytoplasmic glycogen may be demonstrated by PAS stain in 75 % of the cases.…”