EWING SARCOMA IN AN OCTOGENARIAN

Abstract

Ewing sarcoma is a round‐cell bone tumor that most often affects older children and adolescents1. Although less common, Ewing sarcoma in adults has been documented in clinical reports; the tumor primarily occurs in patients less than forty years of age, and the oldest patient in whom it was previously reported was sixty-one years of age1. The prognosis in adults and their response to current treatment modalities have been topics of discussion in recent studies. Diagnosis is crucial, since lymphoma has a similar cytologic appearance and is more common in the elderly, but it differs in terms of both treatment and prognosis. We present a case of Ewing sarcoma in an octogenarian, in whom the findings on cytologic, histochemical, and cytogenetic examination facilitated accurate diagnosis and directed treatment. An eighty‐one-year-old man presented with a six‐month history of a painless mass of increasing size in the distal aspect of the right thigh. He had not had fever, chills, or weight loss, and he reported no previous malignant lesions in himself or his family. Examination revealed a 15 20-cm soft-tissue mass on the posterolateral aspect of the distal part of the thigh; the mass was firm, nontender, and fixed to the adjacent tissue. The overlying skin was intact and not erythematous. The range of motion of the knee was from full extension to 100 of flexion. The findings on the neurovascular examination were normal, and no inguinal or popliteal adenopathy was present. Radiographs of the right femur revealed a permeative lesion in the lateral aspects of the diaphysis and metaphysis with abundant periosteal new-bone formation. An associated soft-tissue mass was also noted (Figs. 1-A and 1-B). Magnetic resonance imaging revealed …