Abstract
Ewing sarcoma is a bone cancer affecting children and young adult males. It usually
presents as a single bone tumor, but it can also occur in multiple locations. Nevertheless,
Ewing sarcoma is an extremely aggressive tumor capable of metastasizing to other parts
of the body, such as the lungs, bones, liver, and lymph nodes. Cardiac metastases
are rare, indicating a poor prognosis, as they suggest that the cancer has become
more advanced and challenging to treat.
This case report describes a 9-year-old boy who presented with complaints of fever
and multiple swellings in the calvaria, periorbital region, clavicle, and left thigh.
Laboratory investigations revealed a high erythrocyte sedimentation rate, elevated
absolute neutrophil count, high phosphate and calcium levels, and low magnesium levels.
Computed tomography imaging revealed the presence of multifocal osseous expansile
lytic lesions, multiple pulmonary metastases, and extensive soft tissue involvement
of the heart. Based on these findings, possible differential diagnoses of Langerhans
cell histiocytosis, lymphoma, and Ewing sarcoma were considered. Further histopathological
examination and immunohistochemistry confirmed a final diagnosis of metastatic Ewing
sarcoma.
The most common metastasis sites for Ewing sarcoma are the lungs, with rare occurrences
in the central nervous system, and metastasis to the heart is uncommon. We present
here a rare undiagnosed Ewing sarcoma with cardiac metastasis, in addition to pulmonary
and multifocal osseous metastasis. This case is unique because multifocal osseous
involvement is rare and further lung and heart involvement is even rarer in Ewing
sarcoma.
Keywords
Ewing sarcoma - multifocal osseous metastasis - lung metastasis - cardiac metastasis
- case report
