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Imaging Ewings Sarcoma PowerPoint Presentation

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Description : Check out this medical presentation on Bone Cancer (Sarcoma of Bone), which is titled "Imaging Ewing’s Sarcoma", to know about Ewing’s sarcoma (a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents), learn how it has retained the most unfavorable prognosis of all primary musculoskeletal tumors, and the development of multi-disciplinary therapy with chemotherapy, irradiation, and surgery has increased current long-term survival rates.

Tags : Bone Cancer, Sarcoma, Bone, Imaging, Ewing’s Sarcoma

Published on : May 10, 2021 | Views : 2900 | Downloads : 9

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IMAGING EWING’S SARCOMA A.BERRICH, W.GAMAOUN, N. MAMA, I. HASNI, M. BEN MAITIG, N. ARIFA, K. TLILI. Medical Imaging CHU Sahloul Sousse Tunisia
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Definition : Ewing’s sarcoma is a small round-cell tumor typically arising in the bones, rarely in soft tissues, of children and adolescents. Ewing’s sarcoma has retained the most unfavorable prognosis of all primary musculoskeletal tumors. The development of multi-disciplinary therapy with chemotherapy, irradiation, and surgery has increased current long-term survival rates.
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Epidemiology 2 nd most common primary osseous malignancy in children Incidence is 2.1 / million Males > Females 65% in the 2nd decade of life Rare in blacks and Asians
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LOCALIZATION Ewing’s sarcoma demonstrates a predilection for the trunk and long bones. In the truncal skeleton, the pelvis predominates, followed by the scapula, vertebral column, ribs and clavicle. Of the long bones, the most common site is the femur, followed by the humerus, tibia and bones of forearm in that order.
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LOCALIZATION As opposed to osteosarcoma, Ewing’s sarcoma of the long bones tends to arise from the diaphysis rather than the metaphysis. Ewing’s sarcoma has a strong potential to metastasize. Metastases most commonly occur in the lungs and bone. More than 10% of patients present with multiple bone metastases at initial diagnosis. While metastases in the lungs, bone, bone marrow, or a combination thereof are detectable in approximately 25% of patients, metastases to lymph nodes are rare.
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LOCALIZATION Ewing’s sarcoma primarily occurs in bones, with rare occurrences in soft tissues. Most extra-skeletal Ewing’s sarcomas affect patients between 10 and 30 years of age, with a peak incidence at approximately 20 years old. The most common sites are the chest wall, para-vertebral muscles, extremities, buttocks and retro-peritoneal space. Extra-skeletal Ewing’s sarcomas present with rapid growth and frequent distant metastases, similarly to Ewing’s sarcoma of bone.
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SYMPTOMS Ewing’s sarcoma typically progresses quite rapidly. Skeletal lesions typically progress to large tumors that form in soft tissues within a few weeks. The earliest symptom is pain. At ﬁrst, the pain can be intermittent and mild, but rapidly progresses to the point at which it becomes so intense as to require the use of analgesic drugs. When the tumor is vertebral or pelvic in origin, the pain may be accompanied by paresthesia and treated by irradiation.
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Imaging Evaluation of Ewing Sarcoma Imaging in Ewing sarcoma can help to : (a) detect and accurately assess the extent of disease prior to treatment. (b) evaluate for the presence of metastatic or recurrent disease. (c) monitor therapy response.
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Imaging Evaluation of Ewing Sarcoma Conventional radiography and magnetic resonance (MR) imaging of the primary tumor. Tomography (CT) to evaluate for pulmonary metastases. Bone scintigraphy to identify osseous metastases.
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DIAGNOSTIC IMAGING PLAIN RADIOGRAPH : The initial imaging investigation of a suspected bone tumor is a radiograph in two planes. Tumor-related osteolysis and periosteal reactions suggest a diagnosis of primary malignant tumor. Periosteal reactions, the reactive osteogenesis of the periosteum, are caused by extra-osseous extension of the tumor.
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DIAGNOSTIC IMAGING Several types of periosteal reactions have been observed: an ‘onion skin’ or ‘onion-peel appearance’ is a prominent multi-layered reaction, a ‘sunburst’ or ‘spiculae’ pattern is a perpendicular reaction, while ‘Codman’s triangle’ is a triangular lifting of the periosteum from the bone at the site of detachment. Typically, Ewing’s sarcoma appears as an ill-deﬁned, permeative, or focally moth-eaten, destructive intramedullary lesion accompanied by a periosteal reaction (‘onion skin’) that affects the diaphyses of long bones. The sunburst type of periosteal reactions can present, but is less common in comparison with its occurrence in osteosarcoma.
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MRI The most precise deﬁnition of the local extent of bone tumors, including the degree of expansion into the intra medullary portion and the relationship of the lesion to adjacent blood vessels and nerves, is provided by MRI. When malignant bone tumors are suspected, MRI is routinely performed for staging and surgical planning. MRI is particularly important in the imaging of Ewing’s sarcoma.
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MRI MRI typically demonstrates lesions that involve large segments of the intramedullary cavity, which extend beyond the area indicated by plain radiographs. MRI can also evaluate the extent of soft tissue masses, which can be quite large. MRI is widely used to assess responses to neoadjuvant chemotherapy or irradiation, because regression of the extra skeletal tumor mass can be precisely deﬁned. Currently, MRI is the standard imaging method for such evaluation. Recent studies have demonstrated, however, that PET, thallium-201 scintiography and dynamic MRI provide more valuable information than MRI for assessment of therapeutic responses.
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- 14 years. Localization : distal femur. MRI : precise expansion into the intra medullary portion and the relationship of the lesion to adjacent blood vessels and nerves. - Ttt : chimio + resection and prothesis. - Metastasis after 18 month. CASE n° 1
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12 years old ewing sarcoma of the pelvis with imporant loco-regional expansion. surgical traitement after chimiotherapie. Case N°2
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Case N3 : Surgical resection of the Tm and Arthrodesis RX after 6 years A girl : 18 ans years old Ewing sarcome of fibula. Surgical traitement and good evolution.
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Girl 19 years old. Ewing sarcoma of the spine. chimiotherapy Case N4 :
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A boy. 20 years old. Pelvic pain. Ewing sarcoma of pelvis. Surgical traitement and chimiotherapy Case N5 :
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Case N6 : 16 years old A boy Ewing sarcoma of pubis. RT- CT Surgical ttt
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19 years old swelling of the back of the hand. RX: osteolysis and periosteal reactions of M3. Ewing sarcoma of the hand. Case N°8 :
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Case N°7 : 20 years old. A boy. Pathologic fracture of the femur. MRI : osteolysis and important perostic reaction Metastasis of ewing sarcoma of right calcaneus
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8 years old. A girl. Ewing sarcoma of the left clavicle. Case N°8 :
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Conclusion : Ewing's sarcoma is a tumor and metastatic bone rapidly progressive in the young age. MRI imaging is essential especially in the early diagnosis and in monitoring post-treatment.