Ewing sarcoma of the chest wall most commonly involves the ribs, and tend to present late in disease course due to indolent growth. Surgical resection for local control is generally preceded by neoadjuvant chemotherapy and/or radiotherapy even in non-metastatic disease in order improve odds of total resection and to reduce the risk of recurrence and subsequent metastasis 1,2.
Imaging findings in this case are typical of thoracic Ewing sarcoma.
This patient was found to have non-metastatic disease, AJCC tumor size >8 cm, T0, M0 is stage IB. There was incomplete response to chemotherapy. Due to positive margins on resection, this patient underwent additional adjuvant radiotherapy in addition to standard adjuvant chemotherapy.