Presentation
Recent cough. No breathlessness. Normal O2 saturations. Has complained of some left sided shoulder pain.
Patient Data
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Lungs are well expanded and clear. Normal heart and mediastinal contours.
Abnormality centered on the left scapula with permeative appearance and bone destruction.
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The abnormality at the left scapula is confirmed and clearly seen as a large soft-tissue mass arising from the scapula and extending posteriorly between the scapular spine and the coracoid. Proximal humerus appears normal.
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Permeative bone destruction of the medial portion of the left scapula. Glenoid spared. Normal proximal humerus.
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Postoperative appearance with removal of scapula. Left sided dual-lumen port-a-cath. NB. the port-
Microscopy
Cores of tissues containing tumor.
Characterized by small round blue cells with a monomorphic appearance.
Prominent vascular pattern with some large vessels.
Fragment of necrotic tumor.
No differentiation.
In some fragments, tumor invades soft tissue.
No bone present. No osteoid formation.
CD99 - positive
Desmin - negative
myo-D1 - negative
myogen - negative
CD45, panCK, S100, PGP9.5, WT1 and ERG - all negative.
Overall appearances of a small round blue cell tumor without differentiation. Most in keeping with a Ewing sarcoma.
Case Discussion
Bone tumors in children can present incidentally, often after trauma. Where a tumor arises from a flat bone (scapula, pelvis, rib) and there is a significant soft tissue mass, consider Ewing sarcoma high up the differential.