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Enlarging Thigh Mass in a 6F

HPI

6F presenting with months of insidiously increasing right mid-thigh pain. Prefers not to bear weight, pain present at rest and night time. No improvement with anti-inflammatory medications. Mother reports fevers.

PMH

Unremarkable No family history of malignancy

PE

MSK - R thigh - able to bear weight but with antalgic gait favoring left side, increased circumference of right thigh with deep, firm, immobile, palpable enlargement of mid-thigh, otherwise intact ROM at ipsilateral knee and hip, limited strength to knee extension and flexion 2/2 pain about mid-thigh, otherwise neurovascularly intact distally

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In addition to plain radiographs, would you obtain additional local imaging to guide management?
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If you were the treating surgeon, how would you confirm the diagnosis?
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The biopsy returns diagnostic of Ewing sarcoma. How would you definitively manage this patient?
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If you choose Operative management, would you include preoperative neo-adjuvant chemo-radiation?
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If you choose Operative management, how would you address resection of the tumor?
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If you choose Wide resection, what type of reconstruction would you plan on?
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If you choose Operative management, would you include any postoperative adjuvant chemo-radiation?
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If you choose to include Adjuvant chemotherapy, for how long would you recommend administration?
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PROCEDURE #1

Neo-adjuvant chemotherapy, wide excision with intercalary spacer placement and internal fixation, adjuvant chemotherapy

Intra-procedure P1
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