Ewing's sarcoma of scapula

Case contributed by Dr Salman S. Albakheet

Presentation

Progressive left shoulder pain, swelling, and restricted range of movements.

Patient Data

Age: 11 years
Gender: Female
X-ray

There is aggressive (moth-eaten) osteolytic lesion involving the left scapula, mainly its spine.

Ultrasound

Well defined heterogeneous lesion (6.8 X 10.5 cm) at left shoulder mainly involves the left scapula, left supraspinatus muscle, and left infraspinatus muscle. It shows increased vascularity on Doppler images. Indistinctness and irregularity of hyperechoic cortex is suspicious for bony erosion of the left scapula.

Nuclear medicine

Whole body bone scan: there is increased radiotracer uptake in the left scapula, suspicious for malignancy. No other significant abnormal bone uptake to suggest skeletal metastasis.

PET-CT whole body scan: there is increased FDG uptake in the soft tissue mass involving left scapula, suggestive of malignancy.  No other significant abnormal FDG uptake to suggest distant metastasis.

 

MRI

Extensive soft tissue mass (9.5 X 6 X 7.6 cm) involving left scapula (including acromion and coracoid) with invasion of the supraspinatus, infraspinatus, and subscapularis muscles.   
This mass shows diffuse high signal with low signal striation on T2 WI, prominent enhancement, and diffusion restriction.   

No definite osteoid matrix/calcification in soft tissue component.  

Multiple borderline lymph nodes in left supraclavicular fossa and axillary area.   

Edematous changes at supraspinatus, infraspinatus, and teres minor muscles. 

Case Discussion

Tissue biopsy was taken from the mass and Ewing's sarcoma was confirmed.

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Case information

rID: 60692
Published: 31st May 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: King Fahad Hospital in Hofuf

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