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

LETTER TO EDITOR
Year
: 2003  |  Volume : 13  |  Issue : 2  |  Page : 235--236

Ewings sarcoma of distal radius : Unusual presentation


KB Taori, R Parate, SU Ingole 
 Govt. Medical College, Nagpur, India

Correspondence Address:
K B Taori
Govt. Medical College, Nagpur
India




How to cite this article:
Taori K B, Parate R, Ingole S U. Ewings sarcoma of distal radius : Unusual presentation.Indian J Radiol Imaging 2003;13:235-236


How to cite this URL:
Taori K B, Parate R, Ingole S U. Ewings sarcoma of distal radius : Unusual presentation. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Oct 29 ];13:235-236
Available from: https://www.ijri.org/text.asp?2003/13/2/235/28669


Full Text

Sir,

We would like to Report a case of Ewings sarcoma that presented at an unusual site in the distal end of radius.

A thirteen year old boy presented with gradually increasing painful swelling of the right distal forearm since 6 months. There was history of fever without discharging sinuses. A provisional clinical diagnosis of Osteomyelitis was entertained and the radiograph of the part was advised.

Radiograph [Figure 1][Figure 2] revealed an ill defined permeative pattern with mild sclerosis involving the metadiaphyseal aspect of distal radius with a wide zone of transition. Associated thin lamellar periosteal reaction proximally and thick complete periosteal reaction was noted distally with scalloping of the underlying cortex. A soft tissue component was noted around the lesion causing scalloping of the lateral aspect of distal Ulna. Radiograph of Chest frontal view [Figure 3] revealed a solitary nodule in right lower zone. Radiological diagnosis was Ewings Sarcoma with metastasis to lung. Fine needle aspiration cytology from the lesion in forearm showed abundant round cells [Figure 4]. Periodic acid-Schiff(PAS) was positive. The patient was managed on usual line with curative radiotherapy and chemotherapy.

Ewings sarcoma is common in both tubular and flat bones. The incidence in the distal radius is unusual and is reported to be only two percent by Dahlin et al and Kissan et al ,both of whom have studied a large series of Ewings sarcoma (1 and 2).

Radiological features show wide variation (3 and 4)from permeative pattern in the shaft of long bones to increased density in 15 % cases and invasion into soft tissues with preservation of soft tissue plains. Periosteal reaction may be Lamellated or may give an 'hair on end' appearance. Cortical destruction with saucerisation may be seen.

The initial lesions tend to infiltrate quickly to metastatise early to remainder of the skeleton, particularly to haemopoietic areas and also to lungs [5]. It can be confused with osteomyelitis, lytic osteosarcoma, secondary neuroblastoma and primary lymphoma in patient above thirty years of age.[5]

References

1Kissane J M, Askin FB, Foulkes, et al:Ewings Sarcoma of bone:Clinicopathological aspects of 303 cases from intergroup Ewings Sarcoma study. Hum Pathol 14:773-779,1983
2Dahlin DC, conventry MP , Scanlon PW : Ewings Sarcoma : A critical analysis of 165 cases . J.Bone and joint surgery (Am) 43 : 185-192 ,1961
3Vohra V G 1967Roentgen manifestations in Ewings sarcoma :a study of 156 cases. Cancer 20:727-733
4Eggli KD, Quique T , Moser RP 1993 Ewings sarcoma. Radiol clin of North America 8:869 -881
5Murray RO, Jacobson H G, Stoker DJ 1989 The Radiology of Skeletal Disorders.3rd edn. Churchill Livingstone, Edinburgh