ATYPICAL PRESENTATION OF METASTATIC EWINGS SARCOMA OF PUBIC BONE-A RARE CASE

Ewings sarcoma is a highly malignant bone tumor which usually occurs in children and young adults and is not common in adults older than 30 years. It often arises from diaphysis of long bones. Although it may develop in any bone, the most frequent sites are femur, ilium, tibia, pelvic area, ribs and scapulae. A delay in early symptoms and diagnosis is quite common, particularly of pelvic tumors in which this mass is not palpable until it is quite large. The most important and earliest symptom is pain which may radiate to the limbs and constitutional symptoms (such as malaise and fever). Majority of patients have metastasis involving the lungs and other bones. Ewings sarcoma involving the pelvis is a great challenge in terms of local control due to the complexity of pelvic anatomy, which increases the difficulty of treating them. We report a rare case report of Ewings sarcoma of right pubic ramus with metastasis to lungs and spine in a 19 years old male. Further multislice spiral CT pelvis, Magnetic Resonance Imaging (MRI) of dorsal and lumbar spine and nuclear medicine positron emission tomography (PET-CT scan) was done to assess the involvement of soft tissue and proven Ewings sarcoma. He was treated by a multidisciplinary approach by surgery, chemotherapy (CT) and radiation therapy (RT) for effective response. The prognosis and survival of patients in this location (pelvis) are much less favourable than for patients with tumors of other extremities.