A Radiological Review of Ewing's Sarcoma of Mandible: A Case Report with One Year Follow-up

A Rare Case of Ewing's Sarcoma of Maxilla Managed with a Newly Proposed Multimodality Approach to Achieve Optimal Outcome

Rare case of Ewing's Sarcoma of maxilla managed with newly proposed multimodalityapproach in which First neo-adjuvant chemotherapy was done to shrink the size oftumor mass and control possible occult distant metastasis and in the second phase surgical management that is followed by adjuvant chemotherapy was done. During Surgical phase, instead of doing a complete surgical resection, we have decided intraoperatively and performed only curettage of the tumor mass left after shrinkage of the tumor mass post chemotherapy phase. This concludes that there is the scope of trying newer ideas for management and, thus, more contemporary approaches for this rare entity. Like in our case, curettage of the tumor rather than radical resection as a part of multimodality approach also gave optimal outcome.

Unusual case presentation associated with impacted mandibular molars: Clinicopathological correlation and immunohistochemical analysis

ABSTRACT

Ewing's sarcoma of bone is a rare malignant round cell tumor of the head and neck. The jaw, particularly the mandible, accounts for 3% of occurrences in the head and neck area. These tumors have been reported more frequently in men than in women, and they are usually between 5- and 20-year-old. It is difficult for clinicians and pathologists to make a diagnosis based solely on clinical and microscopic findings. Immunohistochemistry presents a plausible tool that can help the pathologist to arrive at a confirmatory diagnosis. This jaw tumor has the best prognosis when detected and treated early in the disease course, so the importance of timely, and accurate diagnosis cannot be overemphasized. The highlighting feature of this case report of an 18-year-old male that was primary detected by immunohistochemically as Ewing's sarcoma and is localized to the impacted left mandibular molars.

Ewing's sarcoma masquerading as an odontogenic infection

ABSTRACT

Ewing's sarcoma (ES) is a small, blue, malignant, round cell tumor of unknown origin. ES is the fourth most common malignant bone tumor, whereas among children, it is found to be the second most common primary malignant bone tumor after osteosarcoma. Swelling is usually the first clinical presentation, followed by pain. ES is an aggressive tumor showing rapid growth and metastasis with complex diagnosis. Because mandibular involvement is rare, it can be misdiagnosed as an odontogenic infection/tumor. We report an unusual case of ES in a 13-year-old female treated for an odontogenic infection before a diagnosis of ES was finally made to make the clinicians aware of this rare entity. Emphasis is also given that ES and odontogenic infections/tumors can masquerade each other with delays in diagnosis and the possibility of devastating results.

Primary Ewing’s Sarcoma of Body of Mandible, Multimodal Treatment with Excellent Spontaneous Bone Regeneration: a Case Report

Ewing's sarcoma is an invariable manifestation in facial bones. Primary lesions in head and neck region had come up with better prognosis compared to other primary sites; hence, management of such jaw lesions is a challenge particularly in pediatric patients during first decade of life as functional impairment and facial disfigurement may affect the quality of life. Here, we are discussing a unique case of primary lesion of horizontal region of mandible with special focus on use of radiation therapy, radiation dose-related effects and spontaneous bone regeneration.

A Pattern-based Imaging Approach to Pediatric Jaw Lesions

Jaw lesions in the pediatric population, although infrequently encountered in clinical practice, can cause functional impairment and cosmetic disfiguring. It is further complicated by the difficulty in diagnosis due to complex anatomy and facial developmental process during infancy and childhood. Intraosseous pediatric jaw lesions may vary from odontogenic to nonodontogenic types with nonspecific clinical features in most cases. They deserve careful attention by a systematic approach to provide a relevant diagnosis or differential diagnosis for timely management. Imaging plays a major role in diagnosis with orthopantomograph being the foremost investigation, followed by cross-sectional imaging, essentially computed tomography as a problem-solving tool. This article highlights the imaging spectrum of various jaw lesions in the pediatric population with a pattern-based approach for radiological diagnosis.

Radiographic Diagnosis in the Pediatric Dental Patient

This article emphasizes the selection criteria for radiographic acquisition in children due to the greater sensitivity of children for radiation compared with adults. Diagnosis of common pediatric dental conditions, including dental caries, periodontitis, dental anomalies, cysts, tumors, and traumatic dental conditions, are discussed with relevant clinical scenarios.

Ewing's Sarcoma of Mandible: A Case Report with Review

Aim

To make dentists and pedodontists aware of a possible outcome of a rapidly growing swelling.

Background

Ewing's sarcoma is a rare aggressive variant of small round cell tumors and is an uncommon malignancy that occurs usually in childhood. It constitutes 10–15% of all primary malignant tumors and represents the second most common malignant bone tumor occurring in children and young adults.

Case description

We report a case of Ewing's sarcoma in an 11-year-old male child who reported with a rapidly progressing swelling in the left mandibular posterior region. Panoramic view and computed tomography showed characteristic moth eaten and sun-ray appearance. Fine-needle aspiration cytology revealed a small round cell tumor. Since the exact diagnosis is hard to achieve before biopsy, the condition poses a difficult diagnostic dilemma for the clinician. Histopathology was performed for the accurate diagnosis.

Conclusion

Dentists and pedodontists should develop a high index of suspicion in diagnosing cases with rapidly enlarging intraoral or extraoral swellings as early and correct diagnosis may improve clinical management and survival for patients with this disease.

Clinical significance

Our case report is an attempt to help the dental community in developing familiarity with the clinical presentation of Ewing's sarcoma.

How to cite this article

Ahuja US, Puri N, Gupta D, et al. Ewing's Sarcoma of Mandible: A Case Report with Review. Int J Clin Pediatr Dent 2019;12(5):470–474.

The oral surgeon in the front-line of the diagnosis of Ewing sarcoma: a case report

Introduction: Ewing's sarcoma is a primary malignant bone tumor that affects children and young adults. In rare cases, it affects the bones of the face. The diagnosis is difficult because signs are non-specific. Positive diagnosis is based on a cytogenetic examination showing a specific translocation of the EWS gene. Treatment involves a sequence including chemotherapy, oncological surgery and radiotherapy. Observation: The case presented is that of a 4-year old girl initially sent for suspicion of dental cellulitis. On clinical examination, she had recent mandibular dental mobility and a gingival mucosa swelling. Signs of bone lysis interesting the mandibular symphysis was observed on the orthopantomogram. She had no pain or symptoms indicating neoplasia. This atypical situation led to a bone biopsy who revealed the diagnostic of mandibular Ewing's sarcoma. A suitable medical care in a specialized unit was able to be started without delay. Discussion: The literature reports other cases also wrongly diagnosed as an infectious pathology of dental origin. Conclusion: This case shows that the diagnosis of mandibular Ewing's sarcoma must be evoked in front of any atypical mandibular lesion of the child, regardless of his age or sex. Physicians and dental surgeons specialized in oral surgery are then in the foreground to help establish early diagnosis and ensure rapid management by limiting the functional and aesthetic sequelae related to localization.

Ewing's Sarcoma Family Tumors in the Jaws: Case Report, Immunohistochemical Analysis and Literature Review

Due to the low incidence of the Ewing's Sarcoma (ES) family tumors, the available epidemiology is likely to be unreliable, and at present, there are no standard diagnostic or clinical guidelines outlining their management. This report describes a case of peripheral primitive neuroectodermal tumor (ES/pPNET) which initially mimicked cystic lesions, and describes a comparison between ES and ES/pPNET in the jaws by the World Health Organization classification. This review addressed 63 cases published in the English literature between 1950 and 2016. The majority of cases were ES. Both ES and ES/pPNET mimicked other benign entities such as traumatic, cystic and inflammatory lesions. The patients who died of their disease had a history of metastatic tumors, and primary tumor located in the mandible and maxilla for ES and ES/pPNET, respectively. The differentiation of the ES family tumors from other small blue-cell tumors may be difficult and requires familiarity with histological and immunohistochemical features.

Ewing's Sarcoma of Mandible: An Impressive Case of Spontaneous Mandible Regeneration

Ewing's sarcoma (ES) is an uncommon aggressive bone malignancy that mainly affects children and adolescents. Mandible involvement is quite rare and usually represents metastasis from another skeletal site. Combined therapy including wide surgical resection and preoperative and postoperative chemotherapy has been demonstrated as the mainstay of therapeutic approach. As improved therapeutic modalities have significantly increased survival over the last decades, functional and esthetic reconstruction of the postmandibulectomy defect is usually necessary for patient's total rehabilitation. We report a case of ES of the mandible with special consideration to the postresection spontaneous structural and functional regeneration of the mandible.

HOW TO CITE THIS ARTICLE

Chatzistefanou I, Kabesi S, Paraskevopoulos K, Koliouskas D, Antoniades K. Ewing's Sarcoma of Mandible: An Impressive Case of Spontaneous Mandible Regeneration. Int J Clin Pediatr Dent 2016;9(3):273-277.

Goldenhar Syndrome: A Case Report with Review

Goldenhar syndrome is a rare condition which is characterized by a multitude of anomalies involving craniofacial structures, vertebrae, internal organs and usually occurs unilaterally. The etiology of this syndrome is unclear since it varies genetically and is linked to a plethora of reasons. Herein, we report a case of Goldenhar syndrome with hemifacial microsomia and microtia along with systemic involvement which was clinically and radio-graphically assessed. Many classical signs of the syndrome were present in the patient along with few rare ones. The various aspects of this rare disease have been discussed with emphasis on timely diagnosis and multidisciplinary approach to manage it.

HOW TO CITE THIS ARTICLE

Goswami M, Bhushan U, Jangra B. Goldenhar Syndrome: A Case Report with Review. Int J Clin Pediatr Dent 2016;9(3):278-280.