Ewing's Sarcoma with Metachronous Pulmonary Metastasis after Successful Treatment of Osteosarcoma in a Child

Abstract

A rare case of duplicate tumor, osteosarcoma and Ewing's sarcoma, complicated by metachronous pulmonary metastasis in a child is reported. A nine-year-old girl's osteosarcoma was treated by neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy. Four years later, resection of the chest wall to remove an Ewing's sarcoma had to be performed, followed by chemotherapy and radiotherapy. At the age of 17, the girl underwent a metastasectomy of Ewing's sarcoma metastasis to the lung. Five years later, the patient is free from any recognizable malignant disease. We conclude that after the complete surgical removal of two primary tumors, metastasectomy is an optimal treatment procedure in case of a solitary pulmonary metastasis.

Metachronous Myxofibrosarcoma and Osteosarcoma

“…Histologically distinct synchronous or metachronous sarcomas, including synchronous soft tissue sarcoma and osteosarcoma, have been reported in several studies. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][25][26][27][28][29][30][31][32] To the best of our knowledge, however, only 24 welldescribed examples of histologically distinct synchronous or metachronous sarcomas have been published. These include 18 examples of synchronous or metachronous soft tissue sarcomas [5][6][7][8][9][10][11][12][13] and 6 examples of synchronous or metachronous soft tissue sarcoma and osteosarcoma [14][15][16][17][18] ( Table 1).…”

“…[8][9][10] The soft tissue tumors synchronous or metachronous to osteosarcoma were Ewing sarcoma, liposarcoma, rhabdomyosarcoma, leiomyosarcoma, synovial sarcoma, and inflammatory pseudotumor. [14][15][16][17][18] When a second tumor arises, often the initial clinical suspicion is of recurrent or metastatic tumor. In this case, the second tumor was suspected clinically and radiologically to be a metastasis, which is not surprising as the soft tissue myxofibrosarcoma was grade 2, a tumor with significant metastatic potential.…”

“…35,36 There are clearly identifiable risk factors for the occurrence of a second malignancy in the previously reported well-described cases of synchronous or metachronous osteosarcoma and soft tissue sarcoma. Two patients with Li-Fraumeni syndrome developed soft tissue sarcoma (liposarcoma and rhabdomyosarcoma) following osteosarcoma, 15 3 patients developed soft tissue sarcomas (synovial sarcoma, Ewing sarcoma, and leiomyosarcoma) following chemotherapy treated osteosarcoma, 14,16,18 and 1 patient's osteosarcoma followed radiotherapy for an inflammatory pseudotumor. 14 The etiology of metachronous neoplasia, however, in this case is unclear.…”

“…Only a limited number of well-described examples of morphologically distinct synchronous or metachronous soft tissue sarcomas have been published [5][6][7][8][9][10][11][12][13] and very few examples of synchronous or metachronous soft tissue sarcoma and osteosarcoma are documented in the literature. [14][15][16][17][18] In this report, we describe a case of metachronous soft tissue myxofibrosarcoma and vertebral osteosarcoma.…”

“…Prior Well-Described Reports of Synchronous or Metachronous Histologically Distinct Sarcomas [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Abbreviations: GIST, gastrointestinal stromal tumor; A + W, alive and well; AWD, alive with disease; DOD died of disease.Age not stated.…”