대한흉부영상의학회 Weekly Chest Cases

Case No : 202 Date 2001-09-10

Courtesy of Eun-Young Kang, M.D. / Korea University Guro Hospital, Seoul, Korea
Age/Sex 39 / F
Chief ComplaintPalpable mass on left anterior chest wall for three years

Figure 1
Figure 2
Figure 3
Figure 4

Diagnosis With Brief Discussion

Diagnosis: Ewing's Sarcoma
Radiologic Findings: Chest radiographs show a well-defined, 10cm in diameter, soft tissue mass in left lower anterior hemithorax. On CT scans two different components are seen within the mass; one has a heterogeneous solid mass and the other has a cystic lesion. Left 5th rib is destructed and cortical margins of the rib spread out.
On cut section of the mass (Fig.5), the mass has two main compartments like CT sections. The lesion is originated from the rib without invasion of pleura and lung, histologically.
Brief Review: Ewing sarcoma is a relatively common, highly malignant bone tumor that typically occurs in adolescents and young adults aged 10-25 years. The ribs are frequent sites of primary Ewing tumor accounting for about 10-12% of all cases. However, Ewing’s sarcoma originating from the adult rib is rare in clinical practice.
Radiographically, the lesions may be predominantly lytic or sclerotic or show a combination of bone destruction and secondary reactive changes. In some patients bony changes are subtle and are obscured initially by frequently associated large extrapleural masses or pleural fluid. Abnormalities of the affected ipsilateral hemithorax varied from subtle, isolated rib involvement to solitary rib involvement accompanied by complete opacification of the hemithorax.
Additionally, extraskeletal Ewing's sarcoma is now considered as a single entity of primitive neuroectodermal tumor and Askin's tumor. They are infrequent but highly aggressive tumors that involve the chest wall.
References: 1. Resnick D. Bone and Joint Imaging. 2nd ed. W.B.Saunders Company, Philadelphia, 1996:1055-1059
Keywords: Rib, Malignant tumor,

No. of Applicants : 19

▶ Correct Answer : 7/19, 36.8%

- 嫄닿뎅
- 寃쎈⑥
- 源
-
- IMSL, metz, France Eric Gaconnet
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 10/19, 52.6%

- 怨
-
-
- 源
- 諛
-
-
- CHU Nancy-Brabois, France Denis Regent
- CHU Nancy-Brabois, France Lionel Cannard
- Seoul National University Hospital Tae Jung Kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 202 Date 2001-09-10

Discussion

No. of Applicants : 19