Ewing sarcoma - femur

Case contributed by Samir Benoudina
Diagnosis certain


Atraumatic pain, swelling of left thigh since 2 months. Reduced range of motion of the knee.

Patient Data

Age: 16 years
Gender: Male

There is a lesion located in the distal femur with typical aggressive features of a malignant tumor with:

  • irregular and partial destruction of cortical bone
  • periosteal reaction with Codman triangle formation
  • indistinct zone of transition
  • perpendicular spiculations producing a sunburst appearance
  • associated large soft tissue swelling

Histologically proven Ewing sarcoma.

Annotated image
  • Green: Cortical bone destruction
  • Pink: Periosteal reaction
  • Arrow: Codman triangle
  • Blue: Sunburst appearance
  • Yellow lines: Cortical thinning
  • Gray lines: soft tissue expansion

Case Discussion

Pathologically proven Ewing sarcoma. This is a highly malignant bone tumor seen in the first two decades of life. The main differential diagnosis is osteosarcoma.

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