대한흉부영상의학회 Weekly Chest Cases

Case No : 1376 Date 2024-03-05

Courtesy of Hyun Jin Kim, Eun-Ju Kang / Dong-a University Hospital
Age/Sex 38 / F
Chief ComplaintDyspnea (onset: 2 months ago) Past history: none

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Diagnosis With Brief Discussion

Diagnosis: Extraskeletal ewing sarcoma
Radiologic Findings: Fig 1. Chest PA shows large amount of left pleural effusion.
Fig 2-5. CT scans reveal multiple pleural-based heterogeneous enhancing masses in the left hemithorax. The largest one of the masses is measured about 9.8 x 7.5 x 9.0 cm. There is no evidence of invasion of the adjacent chest wall or rib. Left pleural effusion with passive atelectasis of the left lower lobe is noted.
Fig 6. No metastatic nodules are noted in both lungs.
Brief Review: A percutaneous biopsy was performed under ultrasonographic guidance. The histology of the specimen showed diffuse proliferation of small round cells. Immunohistochemically, the tumor cells were diffusely positive for CD99+.

Thoracopulmonary extraskeletal Ewing sarcoma (EES) is a rare disease in the pediatric group, even rarer in adults, and is predominantly seen in White patients. It typically manifests as a painful chest wall mass with symptoms of cough, respiratory distress, weight loss, anorexia, Horner syndrome, or regional lymphadenopathy.
Radiologically, thoracopulmonary EES often manifests as an aggressive unilateral pleural-based mass. Direct invasion of the chest wall musculature or ribs, mediastinum, or lung is common. Pleural effusions are often large, with loculated fluid sometimes forming a pseudotumor. Ipsilateral mediastinal or hilar adenopathy manifests in about 25% of thoracopulmonary EES cases. As with other sites of EES, calcifications are infrequent and are seen in approximately 10% of cases. MRI may be particularly useful for helping determine the presence and extent of chest wall muscle invasion
References: 1. RadioGraphics 2022; 42:1145
Keywords

No. of Applicants : 73

▶ Correct Answer : 18/73, 24.7%

- The University of Tokyo Hospital , Japan JUN KANZAWA
- , Korea (South) DONG-HO BANG
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Other , Korea (South) SEONGSU KANG
- , Japan YOSHIKI ISHII
- Gifu University Hospital , Japan Yo Kaneko
- Kyoto University Hospital , Japan YASUHISA KURATA
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Mie university , Japan SHIKO OKABE
- GHICL , France MANUEL TOLEDANO
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Kyoto University , Japan SHO KOYASU
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- , Japan YUMI MAEHARA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Correct Answer as Differential Diagnosis : 9/73, 12.3%

- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Other , Korea (South) CHAEHUN LIM
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Paras hospital, Panchkula , India SHALEEN RANA
- Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO

▶ Semi-Correct Answer : 9/73, 12.3%

- Showa General Hospital , Japan MASAFUMI KAIUME
- Kyoto University , Japan AKIHIKO SAKATA
- , Korea (South) JIN YOUNG LEE
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Korea University Guro Hospital , Korea (South) LEE DAKYONG
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- TB centre kasaragod. , India rikhy krishnan
- Juntendo University , Japan YUTAKA IKENOUCHI
- Jiangsu province hospital , China WANGJIAN ZHA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1376 Date 2024-03-05

Discussion

No. of Applicants : 73