Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 1999  |  Volume : 9  |  Issue : 1  |  Page : 34--35

Metatarsal Ewing's sarcoma : An unusual presentation


AL Chauhan1, Rohitashwa Dana2, Anil Arora3, Sandya1,  
1 Department of Radiodiagnosis, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
2 Department of Radiotherapy, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
3 Department of Orthopaedics, Dr. S.N. Medical College, Jodhpur, Rajasthan, India

Correspondence Address:
A L Chauhan
Department of Radiodiagnosis, Dr. S.N. Medical College, Jodhpur, Rajasthan
India




How to cite this article:
Chauhan A L, Dana R, Arora A, Sandya. Metatarsal Ewing's sarcoma : An unusual presentation.Indian J Radiol Imaging 1999;9:34-35


How to cite this URL:
Chauhan A L, Dana R, Arora A, Sandya. Metatarsal Ewing's sarcoma : An unusual presentation. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Sep 22 ];9:34-35
Available from: http://www.ijri.org/text.asp?1999/9/1/34/28373


Full Text

Sir,

Ewing's sarcoma is a rare malignant neoplasm, most common in childhood and adolescence. It is common in both the axial and appendicular skeleton but has rarely been reported in the foot [1].

A thirteen years old girl presented with gradually increasing painful swelling of the right foot which persisted for three months. There was no history of discharging sinuses. Mycetoma of the foot was the provisional clinical diagnosis. Radiographs of the foot showed soft tissue swelling over the forefoot with spiculated periosteal reaction in the fourth metatarsal. The rest of the bones of the foot showed disuse osteoporosis [Figure 1]. The radiological provisional diagnosis was fungal osteomyelitis or Ewing's sarcoma. The hemogram, liver function tests, serum creatinine and blood urea were normal with a normal skeletal survey.

Fine needle aspiration cytology (FNAC) from the lesion showed round cells in abundance. The probable diagnosis was round cell tumor involving the soft tissues of the foot. An open biopsy from the fourth metatarsal revealed Ewing's sarcoma. The patient refused below knee amputation. She was managed on usual lines with curative radiotherapy and chemotherapy, which resulted in regression of the swelling and new bone formation.

Another 22 years old man presented with a painful swelling in the region of the second metatarsal of the left foot for 6-8 months. Radiographs of the foot showed expansion and almost complete destruction of the proximal two-thirds of the second metatarsal [Figure 2]. The radiological diagnosis was enchondroma of the second metatarsal with malignant change. The blood chemistry and chest radiograph were normal. An open biopsy from the lesion revealed Ewing's sarcoma. A below knee amputation was performed and chemotherapy started.

Ewing's sarcoma of the metatarsal bone is a very rare tumor. Shirley et al [2] reported an incidence of one to four percent of all Ewing's sarcomas. Sancrassagra [3] reviewed the largest series of 433 cases of Ewing's sarcoma, in which two were found involving the metatarsal bone.

Radiographic appearances are known to show wide variation; they can resemble osteomyelitis, osteogenic sarcoma and metastatic deposits. These were described by Vohra [4] and observed in our patients as well. Despite the short tubular bones being a very rare site, it is suggested that with such a radiographic presentation, Ewing's sarcoma should also be considered in the differential diagnosis.

References

1Leeson MC, Smigh MJ. Ewing's sarcoma of the foot. Foot Ankle 1989; 10: 147-151.
2Shirley SK, Askin FB, Gilula LA et al. Ewing's sarcoma in bones of the hands and feet: a clinico-pathologic study and review of the literature. J Clin Oncol 1985; 3: 686-697.
3Sandrasagra FA. Ewing's sarcoma of metatarsal bone. Ceylon Med J 1973; 18: 58-61.
4Vohra VG. Roentgen manifestations in Ewing's Sarcoma : A study of 156 cases. Cancer 1967; 20: 727-733.