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Wright A, Desai M, Bolan CW, Badawy M, Guccione J, Rao Korivi B, Pickhardt PJ, Mellnick VM, Lubner MG, Chen L, Elsayes KM. Extraskeletal Ewing Sarcoma from Head to Toe: Multimodality Imaging Review. Radiographics 2022; 42:1145-1160. [PMID: 35622491 DOI: 10.1148/rg.210226] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare subtype in the Ewing sarcoma family of tumors (ESFT), which also includes Ewing sarcoma of bone (ESB) and, more recently, primitive neuroectodermal tumors. Although these tumors often have different manifestations, they are grouped on the basis of common genetic translocation and diagnosis from specific molecular and immunohistochemical features. While the large majority of ESFT cases occur in children and in bones, approximately 25% originate outside the skeleton as EES. Importantly, in the adult population these extraskeletal tumors are more common than ESB. Imaging findings of EES tumors are generally nonspecific, with some variation based on location and the tissues involved. A large tumor with central necrosis that does not cross the midline is typical. Despite often nonspecific findings, imaging plays an important role in the evaluation and management of ESFT, with MRI frequently the preferred imaging modality for primary tumor assessment and local staging. Chest CT and fluorine 18 fluorodeoxyglucose PET/CT are most sensitive for detecting lung and other distant or nodal metastases. Management often involves chemotherapy with local surgical excision, when possible. A multidisciplinary treatment approach should be used given the propensity for large tumor size and local invasion, which can make resection difficult. Despite limited data, outcomes are similar to those of other ESFT cases, with 5-year survival exceeding 80%. However, with metastatic disease, the long-term prognosis is poor. ©RSNA, 2022.
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Affiliation(s)
- Alexandra Wright
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Madhura Desai
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Candice W Bolan
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Mohamed Badawy
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Jeffrey Guccione
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Brinda Rao Korivi
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Perry J Pickhardt
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Vincent M Mellnick
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Meghan G Lubner
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Longwen Chen
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Khaled M Elsayes
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
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