ewing’s sarcoma
TRANSCRIPT
![Page 1: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/1.jpg)
Ewing’s Sarcoma
![Page 2: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/2.jpg)
Overview
• Introduction
• Epidemiology
• Clinical Presentation
• Radiology
• Pathology
• Staging, Prognosis, Treatment
![Page 3: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/3.jpg)
Introduction
• Identified in 1921 by James Ewing
• Differed from osteogenic sarcoma
• Different location
• Poor survival: 5-10% at 5 years
![Page 4: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/4.jpg)
Introduction
• 1967: radiation primarily
• 1969: adjuvant chemotherapy
• More long term complications
![Page 5: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/5.jpg)
Epidemiology
• Incidence is 0.6 per million
• Males > Females
• 65% in the 2nd decade of life
• Rare in blacks and Asians
![Page 6: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/6.jpg)
Clinical Presentation
History:
• Pain most commonly (90%)
• Swelling (70%)
• Fever (20%)
• Pathological fracture
• Weight loss, malaise
![Page 7: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/7.jpg)
Clinical Presentation
Physical Exam and Labs• Local warmth, inflammation
• Pleural effusions
• Neurological signs if spinal involvement
• ESR, LDH, anemia, leukocytosis
![Page 8: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/8.jpg)
![Page 9: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/9.jpg)
Radiology
• Site
• Size
• Effect on bone
• Response of Bone
• Matrix
• Cortex
• Soft tissue
![Page 10: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/10.jpg)
![Page 11: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/11.jpg)
![Page 12: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/12.jpg)
![Page 13: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/13.jpg)
![Page 14: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/14.jpg)
![Page 15: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/15.jpg)
![Page 16: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/16.jpg)
![Page 17: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/17.jpg)
Pathology
• Cell of origin is unknown
• Previously a diagnosis of exclusion
• Reciprocal translocation
![Page 18: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/18.jpg)
![Page 19: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/19.jpg)
Pathology
• Gross: soft, tan, gray tissue
• Micro: nests of small round cells
• No osteoid or chondroid production
• Surface cell glycoprotein
![Page 20: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/20.jpg)
Pathology
Differential Diagnosis
• Lymphoma
• Osteomyelitis
• OGS
• EG
• MFH
• Metastatic neuroblastoma
![Page 21: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/21.jpg)
Staging and Prognosis
• Local and distal staging
• Bone marrow aspirate
• Pre-chemotherapy investigations
• Biopsy
![Page 22: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/22.jpg)
Staging and Prognosis
• Location
• Tumor Size
• Metastases at diagnosis
• Response to chemotherapy
![Page 23: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/23.jpg)
Treatment
• Multidisciplinary approach
• Neoadjuvant chemotherapy, surgery
• Don’t prolong interval between chemo
• Radiation if indicated
![Page 24: Ewing’s sarcoma](https://reader037.vdocuments.site/reader037/viewer/2022102705/556af621d8b42a2a4f8b47dd/html5/thumbnails/24.jpg)
Summary
• Rare but common
• Main ddx is lymphoma and infection
• Large soft tisse masses
• Neoadjuvant chemo and surgery
• 75-80% disease free survival at 5 years