Sarcomasdown arrow

General sarcoma

Osteogenic sarcoma

Rhabdomyosarcoma

 

 

Ewing sarcoma

 

 

Disease Spread

Ewing sarcoma (ES):

  • Invades locally with bone destruction, involvement of adjacent soft tissues and intramedullary spread.
  • Very rarely spreads to adjacent lymph nodes.
  • Is most frequently associated with distant metastases - almost always hematogenous
    • Most cases of ES have microscopic (clinically undetectable) spread at diagnosis. 
    • Upwards of 50% of patients have clinically detectable metastatic disease at presentation. 

 

ES routes of spread:

Local
  • Tumor infiltrates bone marrow and adjacent soft tissue
  • Plain films show a permeative destructive lesion of bone
  • The periosteum is typically displaced by the underlying tumor, resulting in the sign of Codman triangle
  • An associated soft tissue mass is typical
  • New bone formation is typical

Distant
  • If ES is treated without systemic chemotherapy, at least 90% of patients develop distant metastases
  • Common sites for metastases: lungs, bone marrow, and bones
  • Metastases to lymph nodes are rare

 

Most common sites for ES metastatic disease:

Site

Proportion of Metastases

Lung

38%

Bone

31%

Bone marrow

11%

 

The CT below shows a pulmonary metastatic deposit in a young woman with ES (#1 - the small round mass in the left costophrenic sulcus).

 

 

Below is a MR showing a metastatic deposit to the brain (#2) of a young woman who had a primary ES of the femur. This is very unusual.

 

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