Ewing's sarcoma of the tibia

Case contributed by Domenico Nicoletti


Young dancer with knee pain for about three months.

Patient Data

Age: 14 years
Gender: Female

Right knee


In the lateral projection in the proximal diaphysis of the tibia, there is an oval-shaped lytic lesion, with a shaded transition zone (2 centimeters length).

The patient returns after three years without having done any therapy or further assessment, with pain and swelling of the knee.

Right knee


Large osteolysis of the proximal tibial metadiaphysis that arise in medullary cavity with extensive permeative lesion of the medial cortex and modest extraosseus component.
There is no periosteal reaction. The transition zone is poorly defined.

Guided biopsy


Guided CT biopsy of the lesion.


Histological report

Case Discussion

Ewing sarcoma involves long bones presenting as a permeative pattern of bone destruction. Periosteal reaction is common. Commonly involves metadiaphysis of long bones. CT to evaluate bone destruction and extra-osseous involvement while MRI is method of choice for tumor staging for assessment of soft tissue involvement.

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