Tumoral thrombosis of inferior vena cava and iliac veins resulting in unilateral lower limb edema in a young adult: A rare presentation of skeletal Ewing's sarcoma

Abstract

Association of venous thromboembolic events (TEs) with malignancy is well known. Ewing's sarcoma usually presents as swelling at the primary site, however presenting as unilateral lower limb edema due to tumoral thrombosis of right iliac vein and IVC is a rare event. A 30-year-old male patient with extensive right lower limb swelling was admitted and imaging studies (plain film, ultrasonography, Doppler, computed tomography) revealed a mass arising from right iliac bone, adjoining sacrum and tumoral thrombosis of right iliac veins extending into inferior vena cava. Histopathological diagnosis was Ewing's sarcoma. Patient was treated successfully with chemotherapy and surgical embolectomy. So a young patient presenting with deep vein thrombosis should be investigated not only to establish any thrombophilic pre-disposition, but also let the clinician to suspect for any local malignancy. Treatment depends upon the proximal extent of tumoral thrombus. With advances in imaging and chemotherapeutic regimens early diagnosis is possible and appropriate treatment planning improves the prognosis. To our knowledge skeletal Ewing's sarcoma with bland thrombosis is a known entity however no such case with direct invasion of tumor into veins leading to tumoral venous thrombosis has been reported in medical literature.