Ewing's sarcoma with distant metastasis: A brief note on management and emerging therapies

An unusual presentation of extraskeletal vaginal Ewing sarcoma: A case report

Ewing sarcoma (ES) is a rare, aggressive malignancy that typically arises from bone and is seen more in adolescents and young adults. In contrast, extraskeletal Ewing sarcoma (EES) is more prevalent in adults and women [1,2]. There is no standard treatment for extraskeletal tumors, especially those in sensitive areas, such as the vagina, where resection may cause a large cosmetic or functional deformity. This case features a woman in her 20s who presented with painless vaginal bleeding and was found to have a 4 × 5 × 4-mm EES of the posterior vaginal wall. The presentation raised both reproductive and functional concerns, as the patient was young, sexually active and of childbearing age. The patient underwent treatment with radiation therapy and chemotherapy every 3 weeks. Given the lack of guidance and proclivity of EES to metastasize, it is paramount to proceed with standard-of-care treatment even if it is small and there is a lack of metastatic disease. For women with vaginal EES who are of childbearing age, brachytherapy rather than surgical resection may be a more favorable option when considering the location and the potential impact of vaginectomy.

A Rare Presentation of Ewing's Sarcoma Presenting in the Third Metatarsal

Ewing's Sarcoma family of tumors are rare, malignant round cell tumors arising from undifferentiated mesenchymal cells. This aggressive neoplastic disease has a quick metastatic onset often resulting in a poor prognosis. In this case study we present a 21-year-old female diagnosed with Ewing's sarcoma of the third metatarsal bone. She initially presented in the emergency room with a 2-day onset of right foot pain following a minor injury. Radiographs taken in the emergency room revealed a cystic lesion in the third metatarsal. The patient presented to the author's clinic and following evaluation, surgical excision and curettage of the bone cyst was performed supplemented with allogenic bone graft. Due to a high clinical suspicion of malignancy, intraoperative culture and biopsy of the third metatarsal were sent to pathology and microbiology. Following evaluation of the bone biopsy with immunohistochemical staining as well as fluorescent in-situ hybridization studies, a diagnosis was made for Ewing's Sarcoma. This case report serves to display the significance of a timely workup as well as the importance of multiple pathology assessments to obtain a definitive pathologic diagnosis when clinical suspicion of malignancy is high.