Extraosseous sinonasal tract metastasis of Ewing's sarcoma presenting with sixth cranial nerve palsy

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Ewing's sarcoma (ES) is a rare, aggressive, and fatal malignancy of bones and soft tissues that affect children and adolescents. It has a high potential of hematogenous metastasis, with lungs, bones, and bone marrow being the most common sites. Extraskeletal metastasis of Ewing's sarcoma in the sinonasal cavity is rare and usually presents with nasal complaints and periorbital swelling. Diplopia as the presenting complaint of sinonasal tract metastasis of Ewing sarcoma has not been reported in the literature. A high suspicion for metastasis should be kept in mind in patients presenting with atypical ophthalmic findings of Ewing sarcoma and appropriate radio imaging should be procured for early intervention.