Ewing sarcoma: right acetabulum

Case contributed by Dr Rishikesan Ramaesh

Presentation

Young female presents to the general surgeons with a 2 month history of insidious right groin and abdominal pain radiating into the right hip and knee. She reports the pain is unaided by simple analgesia. O/E - Range of motion in the right hip is reduced globally. She walks with antalgic gait. The ESR is raised at 100 and the CRP is also elevated

Patient Data

Age: 16
Gender: Female
Modality: X-ray

Permeative lytic lesion in the right superior pubic ramus.

Modality: MRI

Infiltrative lesion in right acetabulum with bone extension into right superior pubic ramus.  There is a large soft tissue mass that extends medially into obturator internus and displaces the pelvic contents to the left.  There is infiltration surrounding the iliac vessels and extending into the posterior ilio-psoas muscle.  There is also infiltration extending towards the sciatic notch.

Case Discussion

Following the MRI, the patient underwent an ultrasound guided biopsy of the right hip. The resulting specimens demonstrated an Ewing's sarcoma. The patient was referred to the oncologists for chemotherapy and to the gynaecologists for a salpingo-oophrectomy for ovarian cryopreservation.

The patient underwent 2 different regimens of chemotherapy and has been referred to the orthopaedic surgical team for surgical management of the residual disease.

The differential for a limping child is broad. Many cases are due to self limiting conditions such as transient synovitis. However more serious conditions causing a limp include infective conditions such as septic arthritis and osteomyelitis. In this age group slipped upper femoral epiphysis is also possible. Finally malignant conditions such as Ewings, whilst being rare, should be considered in any differential.

Regardless of the underlying condition, the limping child requires a thorough investigation and work-up.

PlayAdd to Share

Case Information

rID: 33007
Case created: 25th Dec 2014
Last edited: 17th Sep 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.