Ewings Sarcoma of the Hand–A Case Report

Abstract

Ewings sarcoma of the hand is relatively rare. Ewings sarcoma can present with minimal pain and swelling of the affected digit. The Erythrocyte sedimentation rate and C-reactive protein may be high. Radiologically, Ewings sarcoma can present with a plethora of features from permeative bone destruction to expansile lesions with or without periosteal reaction. Because of these features, this can be confused with Tuberculosis especially in a country like ours where Tuberculosis is endemic. This leads to starting of inappropriate treatment and delay in diagnosis. We report a case of an 18 year old boy who was initially diagnosed as Tuberculous dactylytis of the proximal phalanx of the little finger. He was started on anti-tuberculous treatment and did not respond to it. Subsequent investigation in our centre which also included an open biopsy, confirmed the diagnosis of Ewings sarcoma. He was treated with ray excision, and chemotherapy. This case is being presented for its rarity and also to emphasize the fact that an open biopsy in suspected cases would be appropriate to confirm the diagnosis. This would prevent delay in diagnosis of rare conditions like Ewings sarcoma.

Review of Histology Results of Hand Masses: A South African Audit

“…Very few cases of malignant bone lesions of the hand are mentioned in the literature, and our study found only one case of EWS. EWS of the hand is relatively rare and presents with pain, swelling, a mass, or with clinical features of infection with fever and elevated inflammatory markers (22). These signs could be confused with a case of tuberculous tenosynovitis in regions where tuberculosis is endemic (22).…”

“…EWS of the hand is relatively rare and presents with pain, swelling, a mass, or with clinical features of infection with fever and elevated inflammatory markers (22). These signs could be confused with a case of tuberculous tenosynovitis in regions where tuberculosis is endemic (22). Proper biopsy-guided management is of the utmost importance.…”

Ewing's Sarcoma of the Finger

“…The most common locations in the hand are the metacarpal and proximal phalanxes. [ 3 ] The thumb (28%) and the middle finger (28%) are most commonly affected. [ 1 ] Men (69%) are affected more than the women, with the average age of occurrence being 18.5 years (5 months–51 years).…”

“…This may be confused with tuberculous dactylitis. [ 3 ] Radiologically, it may be seen as bone destruction and expansile lesion. On X-ray, it may be confused with osteomyelitis due to bone destruction.…”

“…[ 1 ] Compared to the typical radiological findings on other localizations, this sarcoma usually shows different radiological features when it appears on the hand or foot. [ 3 ] In this paper, we present this case of ES that was treated surgically.…”