Ewing sarcoma - 1st metacarpal

Case contributed by Dr Jeremy Jones

Presentation

Thumb swelling and pain but no recent trauma.

Patient Data

Age: 10 years
Gender: Male
X-ray

The thumb metacarpal is expanded with coarse trabeculation and periosteal new bone formation. There is cortical breach medially and the impression of a soft tissue mass associated with the aggressive bone lesion.

The abnormal thumb metacarpal is demonstrated here replaced with tumor and associated with a large extra-osseous soft tissue mass and peritumoural edema.

Case Discussion

The thumb metacarpal is abnormal. There is a tumor centered on the metacarpal which has extended from the bone and into the surrounding soft tissues as an extraosseous soft tissue mass. There is associated edema in the bone and extending into the muscles surrounding the tumor.

This tumor is centered on the bone and in pediatric patients, the short differential for bone tumors runs to:

The age of the patient, location, and soft tissue mass point towards Ewing sarcoma.

Ewing sarcoma was confirmed histologically.

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