Ewing sarcoma - humerus

Case contributed by Dr Jeremy Jones

Presentation

Injury to the left arm while playing football. Pain and reduced range of movement.

Patient Data

Age: 12 years
Gender: Male
X-ray

There is a mid-diaphyseal left humeral lesion which has a permeative appearance and lamellated periosteal reaction. Features are of an aggressive bone lesion.

Zoomed image

X-ray

The aggressive bone lesion as seen on zoomed image. 

CT

A permeative aggressive bone lesion with periosteal reaction involving the mid shaft of the left humerus is confirmed on CT.

MRI

The medullary replacementbone edema and periosteal reaction are all clearly demonstrated on the MRI. The lesion is mid diaphyseal.

Case Discussion

This is an aggressive bone lesion and in a young teen, a mid-diaphyseal lesion is likely to be Ewing sarcoma (which biopsy confirmed). The extent of disease is identified by the low signal on T1, not the high signal on T2 (since this includes edema). It is important to report the size of the lesion, distance from physes, involvement of metaphysis, physis or epiphysis and comment on skip lesions. The whole bone must be imaged.

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