Ewing sarcoma - finger

Case contributed by Maulik S Patel
Diagnosis almost certain

Presentation

Left index finger nodule swelling for about 6 months. An attempt of local excision performed about 2-3 months back. Recurrence of larger lesion locally.

Patient Data

Age: 40 years
Gender: Male
ultrasound

There is a well-defined lesion involving middle phalanx soft tissue.

Location: It overlies middle phalanx, proximal-distal interphalangeal jointS, on the volar side. The lesion extends to the ulnar side. It is separate from bone, tendon, joint.

Size: about 34 x 23 x 20 mm.

Morphology: Hypoechoic/anechoic with echogenic multiple echogenic linear bands. There is no calcification. It shows lobulations. There is posterior acoustic enhancement present. The lesion is not significantly compressible.

Doppler: Significant Arterial flow is noted in the lesion. Digital artery is deep to the proximal part of the lesion. Digital artery passes through the distal part of the lesion. 

Case Discussion

Surgical excision of tumor was done. Immunohistochemistry suggested a high-grade poorly differentiated sarcoma ( Synovial or Ewing sarcoma / Primitive Neuroectodermal Tumor - PNET). RT-PCR test - Ewing sarcoma.

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