Ewing’s sarcoma of the patella

Abstract

Ewing's sarcoma is a relatively rare malignancy, occurring mainly between 4 and 25 years of age. It usually arises from the pelvis, followed by the femur, tibia, and remainder of both the long bones of the extremities and flat bones of the axial skeleton. To the best of our knowledge, Ewing's sarcoma of the patella has never been reported previously. Patellar tumors occur infrequently and represent an uncommon etiology of anterior knee pain. We describe the rare case of a 41-year-old man who presented with a 3-4 month history of escalating right anterior knee pain and swelling. Imaging demonstrated an aggressive patellar tumor with an adjacent soft tissue mass. The diagnosis of Ewing's sarcoma was confirmed by pathology. Physicians should be aware of atypical locations for Ewing's sarcoma and, conversely, of rare tumors arising in the patella and accounting for anterior knee pain. Early recognition of such malignancies allows prompt initiation of treatment, hence improving prognosis.

Primary tumors of the patella

“…BS: Single increased activity in the affected patella. Ewing’s sarcoma [ 65 ] Increasing patellar pain and swelling, limp, impairing function, atrophy of quadriceps, weight loss, night sweats A motor vehicle accident some months prior A warm and swollen knee, painful limitation of flexion, patellofemoral irritability at compression, R: mass-like change, sclerosis, permeative change. MRI: marrow replacement by tumor in the patella, soft tissue mass, lesion of proximal tibial, widespread involvement of bone marrow in the vertebral bodies and sacrum epiphysis.…”

Total patellectomy with extensor mechanism reconstruction following pathological fracture due to patellar Ewing’s sarcoma

“…Fever may also be present, a situation that has to be differentiated from osteomyelitis. The authors, undeniably, agree that these symptoms are not very well specific for the disease; and completely agree with Gorelik et al that Ewing’s sarcoma constitutes an uncommon aetiology of anterior knee pain 3. However, the presence of progressive swelling together with unexplained fever, combined with proper radiological interpretation, should definitely raise the suspicion of some pathology.…”

“…The most common location affected is the pelvis, followed by the femur and tibia 3. The tumour spreads by local infiltration into the medullary canal, cortex and the surrounding soft tissues, and by haematogenous spread to the lungs (57%) and bones (34%) 4…”

Picropodophyllin inhibits the growth of Ewing's sarcoma cells through the insulin-like growth factor-1 receptor/Akt signaling pathway

“…ES is a relatively rare type of malignancy predominantly occurring between the ages of four and 25 (27,28). The aim of current research is to acquire a greater understanding of the biological pathogenesis of ES, and to identify an effective drug for the treatment of ES (29).…”