Ewing’s sarcoma of proximal phalanx of the hand with skip metastases to metacarpals

Abstract

Ewing's sarcoma is the second most common malignant primary bone tumor of childhood and adolescence affecting mainly the diaphysis of long bones and flat bones. This tumor is extraordinarily rare in small bones of the hand and presents as a swelling with atypical radiological features of cystic and lytic lesion with scant periosteal reaction. The common differential diagnosis include osteomyelitis, tuberculosis, enchondroma and benign tumors. Moreover, skip metastasis to adjacent bones is even rarer. The prognosis of this condition is greatly influenced by the presence of metastasis at presentation, further emphasizing the importance of early diagnosis. Multimodality treatment using surgery, radiotherapy and chemotherapy is currently recommended though no consensus exists. We report a case of Ewing's sarcoma of the little finger proximal phalanx which was initially missed and developed skip metastasis to several metacarpals within 4 months.

Ewing’s Sarcoma of the Hand: An Unusual Presentation in a Young Hispanic Male

“…Thus, CT of the chest and bilateral bone marrow biopsies are typically performed at diagnosis [ 1 , 13 ]. Several studies now demonstrate that primary tumors involving the distal extremities reliably favor a better prognosis [ 1 , 3 , 5 ]. This advantage is likely a consequence of their relative isolation and smaller tumor size at presentation [ 1 ].…”

“…Up to 20% of these cancers may present in soft tissues with reports detailing involvement of almost every major organ [1,2]. Ewing's sarcoma of the hand is extremely rare with less than 25 cases reported to date [3][4][5][6][7][8][9][10][11][12]. A small review suggests that Ewing's sarcoma of the hand most commonly involves the proximal phalanx of either the thumb or third digit [3].…”

Subacute Metacarpal Osteomyelitis in a Child

“…Metaphyseal localization in the hand bones are possible but have never been described. Several studies showed that subacute osteomyelitis occurs each time there is a decreased bacterial virulence and an increased host resistance [5][6][7]. Moreover, early antibiotic therapy in acute form seems to have a rule in occurrence of subacute form since it decreases the virulence of infectious agents [4,5].…”

Subungual Ewing sarcoma/PNET tumor family of the great toe: a case report

“…When the possibility of this tumor is confronted in patients older than 30, the physician must first exclude small-cell carcinoma and large-cell lymphoma from the list of differential diagnoses ( 2 ). Although this tumor is stated to comprise almost 6% of the total malignant bone tumors, it is very rare in the small bones of the hands and feet, where the incidence is not more than 1% ( 3 ). The foot bones most commonly involved include the calcaneus and the metatarsals ( 4 ).…”