Review Question - QID 1221

Ewing's sarcoma is a malignant small round blue cell neoplasm which has a predilection for long tubular bones, pelvis, and ribs. The radiographic appearance of "onion-skinning" seen in illustrations A and B is due to the body's periosteal reaction, while illustration C shows the histology where the multiple small round blue neoplastic cells are seen. Ewing's sarcoma is most commonly treated with neoadjuvant chemotherapy, surgical excision, and adjuvant chemotherapy - in particular for tumors located in bones that can be easily resected and reconstructed. For large tumors in areas that either cannot be completely excised or where excision is associated with significant morbidity, some centers consider chemotherapy and radiation therapy without surgical excision. There is a current trend towards surgical resection and away from irradiation for Ewing's sarcoma even though it is radiosensitive, because of the risk of secondary malignancy and growth disturbance due to radiation.

Pierz et al review many of the common bone tumors including Ewing's sarcoma and discuss the relevant diagnostic factors as well as specific treatment protocols for each tumor.