Ewing sarcoma - scapula

Case contributed by Dr Jeremy Jones

Presentation

Recent cough. No breathlessness. Normal O2 saturations. Has complained of some left sided shoulder pain.

Patient Data

Age: 10 years
Gender: Female

Lungs are well expanded and clear. Normal heart and mediastinal contours.

Abnormality centered on the left scapula with permeative appearance and bone destruction.

The abnormality at the left scapula is confirmed and clearly seen as a large soft tissue mass arising from the scapula and extending posteriorly between the scapular spine and the coracoid. Proximal humerus appears normal.

Permeative bone destruction of the medial portion of the left scapula. Glenoid spared. Normal proximal humerus.

Postoperative appearance with removal of scapula. Left sided dual-lumen port-a-cath.

Microscopy

Cores of tissues containing tumor.
Characterized by small round blue cells with a monomorphic appearance.
Prominent vascular pattern with some large vessels.
Fragment of necrotic tumor.
No differentiation.
In some fragments, tumor invades soft tissue.
No bone present. No osteoid formation.

CD99 - positive

Desmin - negative
myo-D1 - negative
myogen - negative
CD45, panCK, S100, PGP9.5, WT1 and ERG - all negative.

Overall appearances of a small round blue cell tumor without differentiation. Most in keeping with a Ewing sarcoma.

Case Discussion

Bone tumors in children can present incidentally, often after trauma. Where a tumor arises from a flat bone (scapula, pelvis, rib) and there is a significant soft tissue mass, consider Ewing sarcoma high up the differential.

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