case_images: PMC7198717_01
case_images: MRI. Axial (a,b) and coronal (d) T2w and axial GdT1 (c) images show two skull lesions located in the right parietal and temporal region, with intense contrast-enhancement. Pituitary gland was normal (e, white arrow) CT axial images (e,f) show infiltrative aspect of the lesion.
case_images: fonc-10-00574-g0001.jpg
case_images: PMC7198717_01_fonc-10-00574-g0001.jpg
case_images: F1
case_images: Brain MRI showed a small lesion in the right occipital region, without significant mass effect, and another lesion in the right temporal region; the pituitary gland appeared normal (Figure 1).
case_images: CT. Coronal (a, bone window) and 3D (b) reconstruction show a voluminous tumor involving the left ischio-and ileo-public branches with extensive bone destruction, speculated periosteal reaction, and partially mineralized soft tissue mass.
case_images: fonc-10-00574-g0002.jpg
case_images: PMC7198717_01_fonc-10-00574-g0002.jpg
case_images: F2
case_images: A bone scintigraphy confirmed multiple secondary bone localizations (vault and skull, skull-base, spine, several ribs, sternum, left scapula, pelvis, both femurs, and the right tibia) (Figure 2).
case_images: The histological picture is a monomorphic proliferation of small round cells with scanty cytoplasm containing glycogen (E&E 10X). The cells shows positive stain for CD99 (immunoperoxidase stain 10X).
case_images: fonc-10-00574-g0003.jpg
case_images: PMC7198717_01_fonc-10-00574-g0003.jpg
case_images: F3
case_images: A biopsy of the mass confirmed Ewing's Sarcoma with EWS/FLI-1 gene fusion diagnosis (Figure 3). The brain CT scan showed a progressive disease correlated by abnormal ACTH levels (50.9 pg/ml; Figure 3).