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Abstract

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Article in Japanese

Case Report

A case of Ewing's sarcoma of the right femur associated with pulmonary metastases detected by fluorodeoxyglucose positron emission tomography

Keishi Sugino1)2)  Kazuma Kishi1)4)  Hisashi Takaya1)  Atsushi Miyamoto1)  Takeshi Fujii3)  Kunihiko Yoshimura1) 

1)Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital 2)Department of Respiratory Medicine, Toho University School of Medicine 3)Department of Pathology, Toranomon Hospital 4)Department of Clinical Oncology, Toranomon Hospital

ABSTRACT

A 32-year-old man was referred to our hospital because of a nodular shadow on his chest x-ray film. Chest computed tomography scan revealed multiple nodules in both lungs. Video-assisted thoracoscopic surgery was performed to diagnose the tumor. Microscopic examination of the resected specimen showed tumor connecting of small round cells. Fluorodeoxyglucose positron emission tomography demonstrated strongly increased uptake in the right femur. Subsequently, magnetic resonance imaging showed a well defined mass, approximately 5 cm in diameter, in the right lateral femur with isointensity on T1-weighted images and high intensity on T2-weighted images. A needle biopsy of the tumor of the right femur was performed. Pathological examination revealed the same findings of the pulmonary lesions. Immunohistochemical staining was positive for CD99 in the tumor cells. Ewing's sarcoma gene rearrangement was found using fluorescence in situ hybridization on frozen-section specimens. Based on these findings, a diagnosis of Ewing's sarcoma was made. The patient died 13 months after the initial detection of the disease despite intensive chemotherapy. In cases of multiple pulmonary nodular lesions in a young patient, metastatic tumors arising from bone soft tissue should be included in the differential diagnosis.

KEYWORDS

Multiple nodular shadow  Bone soft tissue tumor  Ewing's sarcoma  Fluorodeoxyglucose positron emission tomography 

Received 平成19年11月8日

JJRS, 46(7): 564-569, 2008

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