Ewing sarcoma

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Painful swelling of the left iliac region.

Patient Data

Age: 50 years
Gender: Female
ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial C+ portal
venous phase
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Info

There is an osteolytic bone lesion centered on the left iliac wing with a soft tissue component measuring 55 x 50 x 45 mm, isodense to the muscles with vivid heterogeneous enhancement on postcontrast images.

The rest of the chest and abdominopelvic CT is unremarkable except small simple right renal cyst. Lungs were clear (lung window not shown).

mri
This study is a stack
Axial
T1
This study is a stack
Coronal
T1
This study is a stack
Axial
T2
This study is a stack
Axial
STIR
This study is a stack
Coronal
STIR
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Axial T1
fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Axial T1
C+ fat sat
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Info

On MRI sequences the soft tissue component appears relatively isointense to the muscles on T1, high signal on T2 and STIR with heterogeneous enhancement following IV contrast and restricted diffusion on DWI/ADC. The iliacus and gluteus muscles are probably invaded. The hip joint is preserved.

Case Discussion

CT and MRI features of an osteolytic tumor centered on the left iliac wing with a soft tissue component invading probably the iliacus and gluteus muscles, pathologically proven as an Ewing sarcoma.

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