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.