Primary Ewing's sarcoma of the skull

Wykorzystanie klinicznych badań molekularno-genetycznych w opiniowaniu sądowo-lekarskim

Biologia molekularna i genetyka dysponują możliwościami diagnostyki wielu schorzeń, których obecność lub nieobecność ma istotne znaczenie w różnych obszarach opiniowania sądowo-lekarskiego. Celem pracy jest zaprezentowanie przykładów możliwego zastosowania tego rodzaju badań w medycynie sądowej. Spośród opinii opracowanych w Zakładzie Medycyny Sądowej w Katowicach wybrano trzy, z których dwie dotyczyły wniosków posekcyjnych odnoszących się do przyczyny zgonu, natomiast w jednym przypadku – opinii na podstawie akt sprawy mającej związek z podejrzeniem zespołu dziecka maltretowanego. We wszystkich tych przypadkach wyniki przeprowadzonych badań molekularno-genetycznych były ujemne, co zostało uwzględnione przez biegłych podczas formułowania ostatecznych wniosków. Zastosowanie klinicznych badań molekularno-genetycznych w medycynie sądowej jest możliwe i zawsze wnosi istotne informacje rozszerzające możliwości opiniodawcze i ułatwiające postawienie rozpoznania. Obszarami, w których tego rodzaju badania mogą być szczególnie przydatne, są: diagnostyka podłoża powikłań zakrzepowo-zatorowych, nowoczesna zintegrowana diagnostyka morfologiczno-molekularna nowotworów oraz diagnostyka defektów genetycznych tkanki łącznej u dzieci podejrzanych o zespół dziecka maltretowanego. The use of clinical molecular and genetic tests in forensic medical opinions Modern molecular biology and clinical genetics have the ability to diagnose many diseases, the presence or absence of which is important in various areas of forensic medical opinion. The aim of the study is to present examples of possible non-standard application of clinical molecular-genetic tests in forensic medicine. From among all the opinions prepared so far at the Department of Forensic Medicine in Katowice, three were selected two of which concerned post-autopsy conclusions relating to the cause of death, and in one case – opinion based on the files of a case related to the suspicion of a maltreated child syndrome in an infant. In all these cases, the results of the molecular and genetic tests were negative, which was taken into account by the experts when formulating the final conclusions of the opinion. The use of clinical molecular and genetic tests in forensic medicine is possible and always brings important additional information that broadens the possibilities of opinion-making and facilitates diagnosis. The areas in which this type of research may be particularly useful are: diagnostics of the basis of thromboembolic complications, modern integrated morphological and molecular diagnostics of neoplasms and diagnostics of genetic defects of connective tissue in children suspected of having abused child syndrome.

Primary Calvarial Ewing Sarcoma: A Case Series

Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings.

Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome.

Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died.

Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

Differential Diagnosis of Calvarial Tumors: A Series of 8 Cases

Introduction To present and discuss the clinical presentations, investigations, and treatment options for skull bone tumors.

Materials and Methods This study was conducted from January 2019 to December 2019 at the Department of Neurosurgery. During this period, eight patients presented with skull bone tumor in the outpatient department. All patients were thoroughly investigated. Surgery was conducted on six patients and two patients had disseminated carcinoma; hence, surgery was not done. Patients were regularly followed-up after the surgery.

Results In our study, out of eight cases, five were females and three were males. We had two cases of fibrous dysplasia, two cases of osteomas, and one case each of brown tumor, metastases from lung carcinoma, metastases from follicular carcinoma of thyroid, and Ewing sarcoma/primitive neuroectodermal tumor (PNET). Excision of tumor was performed where indicated and adjuvant chemo- and radiotherapy was suggested wherever required.

Conclusion Bony tumors of the skull are uncommon diseases for the neurosurgeons. These tumors require a careful diagnosis with suitable radiological examinations and proper clinical correlation for proper management.

Multiple primary Ewing's sarcomas in cerebral cranium of a child: a case report and review of the literature

Ewing's sarcoma is the second most common pediatric bone tumor. Primary Ewing's sarcoma occurring in the cerebral cranium is exceptionally rare, with only one reported case of multiple tumor lesions in adolescence to date. We report a case of a 5-year-old male patient with multiple primary Ewing's sarcomas associated with the cranial bones, the first pediatric case report to date. We also review 71 cases Ewing's sarcoma involving intracranial extension. The purpose of this article is to provide data concerning the clinical and therapeutic course of multiple primary Ewing's sarcomas in associated with cerebral cranium.