Isolated Skull Metastasis of Ewing’s Sarcoma in a Child

Case Report

Austin J Cancer Clin Res 2015;2(5): 1046.

Isolated Skull Metastasis of Ewing’s Sarcoma in a Child

Puerta P¹*, Guillén A¹, Mora J², Suñol M³ and Ferrer E¹

¹Department of Neurosurgery, University of Barcelona, Spain

²Department of Oncology, University of Barcelona, Spain

³Department of Pathology, University of Barcelona, Spain

*Corresponding author: Puerta P, Department of Neurosurgery, University of Barcelona, Passeig Sant Joan de Déu 2, 08950, Spain.

Received: May 04, 2015; Accepted: June 09, 2015; Published: July 30, 2015


Ewing’s sarcoma (ES) is a rare primary malignant bone tumor usually occurring in children and young adults. It most often affects long bones and pelvis. Metastatic lesions usually occur in lung, bone and the bone marrow. Central nervous system involvement is rare and it most frequently presents with other evidence of tumor recurrence. We present a case of isolated metastasis of ES involving the parietal bone in a 10-year old boy. To our knowledge, three other cases of skull metastasis of ES have been published previously. All of them presented other systemic metastases at the same time. The surgical indication for skull metastasis of ES depends on its location and general condition. Resection of solitary skull metastasis of ES should be as radical as possible, followed by systemic chemotherapy.

Keywords: Ewing’s sarcoma; Skull metastasis; CNS involvement; Children

Case Presentation

Ewing’s sarcoma (ES) was first described by James Ewing in 1921 as a “diffuse hemangioendothelioma of bone” [1,2]. It is a tumor of childhood that arises from the neuroectodermal cells of the medullary cavity [2,3]. ES is a relatively rare tumor in neurosurgical practice. It usually affects long bones of the lower limbs and pelvis [1,2,4,-6]. The predominant sites of metastases include lung, bone and the bone marrow [7]. Metastasis of ES to the central nervous system (CNS) is uncommon [7-9] and skull metastasis of ES in children is extremely rare [6]. We report a 10-year-old patient with an isolated parietal bone metastasis of ES.

A 10-year-old male underwent resection of an ES in the left 5th rib 15 months previously, followed by chemotherapy and local radiation treatment. He had a painless, progressive swelling over his right parietal area. There was no history of headache, vomiting or seizures. Neurological examinations revealed no findings. Physical examination revealed a mass of 4cm in diameter over the right parietal region which was circumscribed, hard and nonpulsatile.

Computed tomography (CT) scan showed an isodense parietal tumor which was homogeneously enhanced by contrast medium. It was partly extracranial and partly intracranial, from de epidural space to the scalp with bone destruction (Figure 1a, b). The FDG PET scan only demonstrated increased of metabolism in the parietal mass, suggesting that it was an isolated metastasis. Bone marrow biopsies were negative.