Presentation
Right hip pain. No history of trauma. No prior medical history.
Patient Data
In retrospect, there is a right iliac bone lytic lesion with a wide zone of transition and loss of normal cortical margins at the right sacroiliac joint and the posteromedial aspect of the iliac crest. Unfortunately, the appearance of the destructive bone lesion was attributed as normal cecum and the study was reported as normal.
Rpt pelvic XR after several mth of persistent symptoms
Significant interval increase of the aggressive lytic lesion now involving most of the right iliac bone and sacroiliac joint. Large soft tissue mass associated.
CT confirms the large aggressive lytic lesion involving much of the right iliac bone, the sacroiliac joint, and right sacral ala. Large soft tissue mass associated with it. The favored differential is an Ewing sarcoma.
Case Discussion
This study shows the importance of having a high level of scrutiny in assessing bones, especially in the setting of pain without trauma and no other cause identified. Often there will be bowel gas overlying pelvic bones, but it should be interrogated to check that there is no aggressive bone lesion underlying. This includes a close assessment of the cortical margins/periosteum.
Histology confirmed Ewing sarcoma with EWSR1/FLI1 fusion on FISH studies, CD99 positive. The patient received multidisciplinary management with surgery, chemotherapy, and radiation therapy.
Unable to process the form. Check for errors and try again.