Ewing Sarcoma of the foot

NewsBot · Nov 13, 2012

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Ewing Sarcoma of the Hand or Foot.
Froeb D, Ranft A, Boelling T, Paulussen M, Klco-Brosius S, Jürgens H, Dirksen U.
Klin Padiatr. 2012 Oct;224(6):348-352.

Ewing Sarcoma (ES) of the hand or foot is a rare clinical condition. Due to the critical site, it is of major importance to choose an optimal procedure for local control in terms of outcome and function. Local therapeutic options for these patients range from: surgery (OP), surgery followed by radiotherapy (OP & RT), or radiotherapy (RT) alone.Data from 80 patients with ES of the hand or foot were analyzed. All patients received chemotherapy according to the protocols of the Cooperative Ewing Sarcoma Study Group (CESS) from 1991 to 2009 (EICESS-92 and EURO-E.W.I.N.G.99). Local therapy consisted of: OP in 39%, OP & RT in 44%, and RT in 12%. In 5% of the patients no local therapy (noL) was performed. Primary endpoint of our study was the event-free-survival (EFS).The 3-year overall EFS was 62% (95%CI 0.50-0.72). Patients with localized disease had a significantly better outcome with an EFS of 77% (95%CI 0.63-0.86), compared to patients with primary disseminated disease with an EFS of 30% (95%CI 0.14-0.49; p<0.001). In comparing local treatment modalities, no significant difference was observed. The 3-year EFS for OP was 61% (95% CI 0.40-0.76), for OP & RT 66% (95%CI 0.47-0.79) and for RT only 70% (95%CI 0.32-0.89) (p=0.253). Patients who did not receive local treatment had an unfavourable prognosis (3-year EFS=0.25; 95%CI 0.01-0.67; p=0.024). A multivariate analysis which included local treatment modality and known prognosticators, showed that primary dissemination was the only significant prognostic factor.Ewing sarcoma of the hand or foot is associated with a favourable outcome. Our data analysed a limited group of patients and thus did not provide a clear indication for a preferred local treatment modality.
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Admin2 · Nov 13, 2012

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NewsBot · Nov 26, 2012

Press Release:
Possible new treatment for Ewing sarcoma

Discovery of a new drug with high potential to treat Ewing sarcoma, an often deadly cancer of children and young adults, and the previously unknown mechanism behind it, come hand-in-hand in a new study by researchers from Huntsman Cancer Institute (HCI) at the University of Utah. The report appears in today's online issue of the journal Oncogene.

"Ewing sarcoma is almost always caused by a cancer-causing protein called EWS/FLI," said Stephen Lessnick, M.D., Ph.D., director of HCI's Center for Children's Cancer Research, professor in the Department of Pediatrics at the University of Utah School of Medicine, and an HCI investigator.

In the lab, Lessnick and his colleagues found that an enzyme, called lysine specific demethylase (LSD-1), interacts with EWS/FLI to turn off gene expression in Ewing sarcoma. By turning off specific genes, the EWS/FLI-LSD1 complex causes Ewing sarcoma development. "This makes LSD-1 an important target for the development of new drugs to treat Ewing sarcoma," Lessnick said.

"For a long time, we've known that EWS/FLI works by binding to DNA and turning on genes that activate cancer formation," said Lessnick. "It was a surprise to find out that it turns genes off as well.

"The beauty, if there's anything beautiful about a nasty disease like this, is that if we can inhibit EWS/FLI, we can inhibit this cancer, because EWS/FLI is the master regulator of Ewing sarcoma," Lessnick added.

While Lessnick and his colleagues worked on EWS/FLI in their basic science lab, Sunil Sharma, M.D., director of HCI's Center for Investigational Therapeutics, professor in the Department of Medicine at the University of Utah, and an HCI investigator, had already focused on LSD-1 as a possible target for new cancer treatments and had been working for several years to design drugs that would inhibit its actions.

"We had found that LSD-1 was important for regulation of a variety of properties in several different cancers, including acute leukemias, breast and prostate cancers," Sharma said.

"After Steve showed that LSD-1 was directly regulating the function of EWS/FLI, we teamed up with him to see whether the LSD inhibitors we had discovered worked in Ewing sarcoma models," Sharma said. "Our tests in Ewing sarcoma tissue cultures show they are extremely potent."

Lessnick and Sharma are now working together to further test LSD inhibitors in animal models as they work toward approval of a first-in-man clinical trial. In addition, Lessnick's basic science research on LSD-1 in Ewing sarcoma continues. "We think it may play a larger role in Ewing sarcoma than simply turning off a handful of genes, and we're looking into that," said Lessnick.

"This is a great example of how collaboration between the therapeutics and basic science programs can lead to new treatments for patients—one of HCI's highest goals," said Sharma.
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NewsBot · Jan 8, 2015

Unusual Form and Location for a Tumor: Multiosseous Ewing Sarcoma in the Foot.
Jamshidi K, Shiradi MR.
Am J Orthop (Belle Mead NJ). 2015 Jan;44(1):E32-E35.

Ewing sarcoma, as the prototype of a small round blue cell tumor of bone, typically affects adolescents and young adults. The most commonly involved sites include the diaphyses of long bones, ribs, and flat bones, such as the pelvis and scapula. We report a case of multifocal Ewing sarcoma involving multiple bones in the foot. Given the multifocal nature of the disease confined to the foot, the initial impression was that of osteomyelitis. We describe the histologic, radiologic, and diagnostic features of the tumor and outline treatment and prognosis. To our knowledge, this is the first report of multifocal Ewing sarcoma involving multiple bones in the foot.
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NewsBot · Jun 16, 2015

Prognostic Factors of Ewing Sarcoma in the Foot:
A Systematic Literature Review
Sara Cathcart, BA, Kelly Noonan, BS, and Emily Sanphy, BS
NYCPM; Podiatric Medicial Review

Introduction
Ewing Sarcoma (ES) is the second most common primary malignant bone cancer in adolescents. It is
most often diagnosed anatomically in long bones, while its manifestation in the foot is rare and recorded
to be approximated 5% of all anatomic locations. The rarity of this neoplasm in the foot often
contributes as a factor in delayed or missed diagnosis. The purpose of this paper will be to give a
comprehensive literature review and analyze the prognostic factors of ES in the foot, location of the
tumor and delay of diagnosis.
Study Design
Systematic Review of the Literature

Methods
A PubMed search was conducted using key words ‘Ewing Sarcoma’ and ‘Foot’ as well as ‘Ewing
Sarcoma’ and ‘Tarsal bone’. Inclusion criteria involved case reports or case series written after 1990
and concerned Ewing sarcoma in the foot bones. Particular attention was given to articles pertaining to
pathogenesis and to diagnosis of Ewing Sarcoma. Exclusion criteria were Ewing Sarcoma reports not
involving the foot or articles dated prior to 1990. Articles written before 1990 were excluded due to the
lack of diagnostic testing and treatment options available prior to that time.
Results
A total of nine case reports were included for analysis.. Ewing sarcoma most commonly occurs in long
bones of adolescents between the ages of 5-20 years old, rarely manifesting in the foot. Ewing Sarcoma
of the foot was found to grow 10-20 times slower than bone cancers in other locations. Radiologic
evaluation seems to have less of a prognostic power in the outcomes of treatment when compared to the
location of the lesion.
Conclusion
Ewing Sarcoma has a significantly slower growth rate in the bones of the foot than in other parts of the
body. Delayed diagnosis and location of the tumor appear to affect the prognosis of Ewing Sarcoma in
the foot; however, based on the reviewed cases, no conclusions can be made to differentiate the
importance of radiographic imaging, timing of diagnosis and affective treatment on the prognosis of
Ewing’s Sarcoma of the foot. Recommendations for the future should include higher level of studies
and research into additional factors that may affect the prognosis of Ewing Sarcoma in the foot.
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NewsBot · Jul 25, 2015

Primary Cutaneous Ewing Sarcoma: Report of a Case.
Yuste V, Sierra E, Ruano D, Llamas-Velasco M, Conde E, Azorin D.
Fetal Pediatr Pathol. 2015 Jul 24

Primary cutaneous Ewing's sarcoma is a rare entity. Although the diagnosis may be very difficult, it can be confirmed through molecular biology. We present the case of a 13-years old male with a lesion in the sole of the right foot, characterized by a monomorphous proliferation of small, round and blue cells. The histology and molecular biology allowed us to perform the diagnosis of cutaneous Ewing's sarcoma. This neoplasm must be distinguished from other round cell tumors with cutaneous involvement. The prognosis and treatment of this rare disease will also be discussed.
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NewsBot · Sep 2, 2015

A peculiar case of large primary cutaneous Ewing's sarcoma of the foot: Case report and review of the literature.
Grassetti L, Torresetti M, Brancorsini D, Rubini C, Lazzeri D, Di Benedetto G
Int J Surg Case Rep. 2015 Aug 18;15:89-92.

INTRODUCTION:
Primary cutaneous extraskeletal Ewing's sarcomas (ESs) are extremely rare tumors, limited to the skin and generally appear as a single small lesion, circumscribed mid-to-deep dermis or involving subcutis. Due to their rarity and morphological similarity to other cutaneous tumors, ESs are subject to being clinically and pathologically subdiagnosed.
PRESENTATION OF CASE:
A 37-year-old man presented a large rapidly growing mass of the first toe measuring 9.5?8cm with no radiological evidence of bone involvement. The patient underwent wide surgical tumor resection; histological, immunohistochemical and molecular evaluation confirmed the diagnosis of ESs. Postoperative examinations revealed no metastasis and after 11 months follow-up no recurrences were detected.
DISCUSSION:
Current literature reports only a few isolated cases or small series. ESs are generally described as small masses with a favorable clinical behavior. Despite lower extremity is a relatively frequent site, only rare and small ESs of the foot have been reported. To our knowledge the present case is the largest ES of the foot. Despite its large size, the patient did not report any metastases confirming the hypothesis of treating superficial ES with surgery alone, thus avoiding adjuvant radiotherapy and/or chemotherapy and their related side-effects.
CONCLUSION:
ESs still remain exceedingly rare tumors and they could not be taken in consideration into differential diagnosis. This case represents a peculiar example of large ES in an uncommon site as the foot successfully treated with surgery alone, and may serve as an alert for those physicians who approach such rapidly growing superficial lesions.
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NewsBot · Jun 10, 2016

Subungual Ewing sarcoma/PNET tumor family of the great toe: a case report.
Binesh F et al
Electron Physician. 2016 Apr 25;8(4):2238-42. doi: 10.19082/2238. eCollection 2016.

Ewing's sarcoma is seen mainly in patients less than 18. This aggressive tumor generally affects the axial skeleton and only rarely involves the acral regions. Ewing's sarcoma in the foot is inordinately scarce. Clinical features are uncertain and can imitate other common diseases. This paper presents a case of 62-year-old malewith complaints of pain and swelling of the subungual area of his right great toe. The lesion was excised, and histopathological diagnosis of Ewing's sarcoma was made. Histopathological examination, supported by immunochemical methods, remains the mainstay of diagnosis. Surgical ablation along with chemotherapy is the therapy of choice. To our knowledge, this is the first report of Ewing's sarcoma involving the nail bed of the great toe without bone erosion. The key messages of this case report is "Subungual Ewing sarcoma is a rare case, and Ewing's sarcoma must be kept in mind for acral lesions, especially in the adult population."
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NewsBot · Aug 23, 2017

Calcaneal Ewing's Sarcoma With Skip Metastases to Tarsals and Lymph Node Involvement: A Case Report
Koray Şahin et al
Jnl Foot Ankle Surgery Article in Press

Ewing's sarcoma (ES) represents the second most common primary malignant tumor of bone of children and occurs rarely in the bones of the foot. Dissemination to regional lymph nodes and skip metastases to adjacent bones are thought to be uncommon. We report a case of a 19-year-old female with the diagnosis of ES of the right calcaneus. Six months earlier, she had presented to the hospital with a history of ankle sprain and was treated with analgesics and ice application. Despite the treatment, the pain over the ankle persisted, her foot swelled progressively, and a mass evolved on the lateral side of the foot. She was referred to our clinic for further treatment options. Radiography and magnetic resonance imaging revealed an expansile mass originating from the calcaneus with talar and cuboidal skip metastases, with concomitant popliteal and inguinal lymph node involvement. The diagnosis was confirmed by histopathologic evaluation after Tru-Cut biopsy. Below-the-knee amputation with popliteal and inguinal lymph node dissection was performed after neoadjuvant chemotherapy. The postoperative first-year follow-up data for the patient showed no evidence of metastasis. The calcaneus is a rare location for the development of ES. A few patients with ES will present with skip metastases to adjacent juxtaarticular bones or regional lymph node involvement. Therefore, the present study has presented a unique case of ES with a rare anatomic location and an unusual metastatic pattern.
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NewsBot · Aug 29, 2017

Calcaneal Ewing's Sarcoma With Skip Metastases to Tarsals and Lymph Node Involvement: A Case Report.
Şahin K et al
J Foot Ankle Surg. 2017 Aug 22. pii: S1067-2516(17)30449-0. doi: 10.1053/j.jfas.2017.07.002.

Ewing's sarcoma (ES) represents the second most common primary malignant tumor of bone of children and occurs rarely in the bones of the foot. Dissemination to regional lymph nodes and skip metastases to adjacent bones are thought to be uncommon. We report a case of a 19-year-old female with the diagnosis of ES of the right calcaneus. Six months earlier, she had presented to the hospital with a history of ankle sprain and was treated with analgesics and ice application. Despite the treatment, the pain over the ankle persisted, her foot swelled progressively, and a mass evolved on the lateral side of the foot. She was referred to our clinic for further treatment options. Radiography and magnetic resonance imaging revealed an expansile mass originating from the calcaneus with talar and cuboidal skip metastases, with concomitant popliteal and inguinal lymph node involvement. The diagnosis was confirmed by histopathologic evaluation after Tru-Cut biopsy. Below-the-knee amputation with popliteal and inguinal lymph node dissection was performed after neoadjuvant chemotherapy. The postoperative first-year follow-up data for the patient showed no evidence of metastasis. The calcaneus is a rare location for the development of ES. A few patients with ES will present with skip metastases to adjacent juxtaarticular bones or regional lymph node involvement. Therefore, the present study has presented a unique case of ES with a rare anatomic location and an unusual metastatic pattern.
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NewsBot · Oct 21, 2022

Primary Extraskeletal Ewing sarcoma of the foot with extensive skeletal and pulmonary metastasis: A rare case report
Oadi N Shrateh et al
Ann Med Surg (Lond). 2022 Sep 21

Introduction: First -degree cutaneous extraskeletal Ewing's sarcomas (ESs) are incredibly uncommon skin-specific tumors that often present as a single, tiny lesion that is restricted to the mid-to-deep dermis or involves the subcutis. ESs can be clinically and pathologically misdiagnosed because of their rarity and physical resemblance to other cutaneous cancers.

Case presentation: A 47-year-old nonsmoking woman was admitted after being transferred from a nearby hospital to check her right foot pain that had been present for three months and was significantly numbing the same side. Only a few lone cases or brief series are reported in the current literature. The typical description of ESs is that they are tiny masses with positive clinical behavior.

Discussion: Despite being a rather common location, only infrequent and minor ESs of the foot are present. After the recommended operation and subsequent histology analysis, we identified this uncommon sort of tumors.

Conclusion: Although it's rare, it's very important to consider this tumor in the differential diagnosis of foot pain with/without visible and/or palpable cutaneous lesion
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NewsBot · Dec 6, 2022

Ewing's Sarcoma of the Talus in an Adolescent Female: An Unusual Case Presentation With Review of Literature
Divesh Jalan et al
Cureus. 2022 Oct 31;14(10)

Ewing's sarcoma is an aggressive primary malignant bone tumor that affects long and flat bones and is commonly seen in children and adolescents. The involvement of the foot especially the talus is an extremely rare entity with less than 15 cases reported in the literature. The rarity and atypical symptoms often lead to delays in diagnosis affecting the prognosis and survival. We present a 14-year-old female with pain and swelling of the left ankle for 18 months. She was being treated previously for an ankle sprain and was later suspected of avascular necrosis of the talus, before presenting to us. Clinicoradiology-pathological workup confirmed the diagnosis of Ewing sarcoma of the talus. Further, the metastatic workup revealed multiple skeletal metastases at the time of diagnosis. The metastatic lesion of the right femur required prophylactic fixation, otherwise, the patient was treated with palliative chemotherapy and radiotherapy. Ewing's sarcoma of the foot involving the talus is extremely rare and is a commonly misdiagnosed entity, affecting the overall prognosis of the patient. A high index of suspicion and a multidisciplinary approach is imperative for its early diagnosis and definitive management.
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NewsBot · Jan 10, 2024

Primary Ewing's sarcoma of the talus
Prabodh Kantiwal et al
BMJ Case Rep. 2023 Dec 7;16(12):e258243

Ewing's sarcoma is a malignant round cell tumour of bones and soft tissues that usually arises from the diaphyseal or meta-diaphyseal parts of long bones and less commonly from flat bones. It occurs rarely in the foot and if occurs, the calcaneus and the metatarsals are commonly involved. We present a case of a young woman diagnosed with primary Ewing's sarcoma of the talus with local spread to adjacent tarsals and the ankle joint. Ewing's sarcoma of feet, if present with even a trivial suspicion of spread either locally or distant, makes limb salvage surgery difficult. So, the treatment with radical surgery or by combined chemotherapy and radiotherapy should be considered-keeping in mind the complex anatomy of the foot and the difficulty in achieving tumour-free margins. Based on this experience, she underwent below-knee amputation. The patient received adjuvant chemotherapy and survived with a disease-free survival at the latest follow-up of 1 year
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Ewing's sarcoma

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