Ewing sarcoma - fibula

Case contributed by Domenico Nicoletti


Localized painful mass at the right leg with systemic symptoms: fever, malaise, weight loss, and an increased erythrocyte sedimentation rate.

Patient Data

Age: 20 years
Gender: Female

Right leg


There is ill-defined osteolytic lesion of the midshaft of the fibula, externally, with the interrupted lamellar periosteal reaction, depicting regions of more aggressive tumor extension into the soft tissue.

Right leg


The poorly defined lesion exhibits permeative bone destruction of the fibula associated with a large soft-tissue mass that show diffuse heterogeneous contrast enhancement.

Histological report


The morphological picture indicates small cell malignancy consistent with Ewing / PNET sarcoma.

Post surgical control study


Control post surgical treatment of bone sarcoma of the fibula.

Case Discussion

Ewing sarcoma has a predilection for the diaphysis of the long bones, as well as the ribs and flat bones such as the scapula and pelvis. MRI may effectively reveal extension through the epiphyseal plate. T1-weighted images show intermediate to low signal intensity, which becomes bright on T2 weighting. Hypocellular regions and areas of necrosis are of lesser intensity. Imaging after contrast reveals signal enhancement of the tumor on T1-weighted sequences. Enhancement occurs only in the cellular areas, allowing differentiation of the tumor from the peritumoral edema. Skip lesions in Ewing's sarcoma of the bone seem to be rare. The skip lesion are located in most cases in the same bone as the primary tumor.

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