Korean J Radiol.  2015 Aug;16(4):783-790. 10.3348/kjr.2015.16.4.783.

Imaging Features of Primary Tumors and Metastatic Patterns of the Extraskeletal Ewing Sarcoma Family of Tumors in Adults: A 17-Year Experience at a Single Institution

Affiliations
  • 1Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea. medimash@gmail.com
  • 2Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
  • 3Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Abstract


OBJECTIVE
To comprehensively analyze the spectrum of imaging features of the primary tumors and metastatic patterns of the Extraskeletal Ewing sarcoma family of tumors (EES) in adults.
MATERIALS AND METHODS
We performed a computerized search of our hospital's data-warehouse from 1996 to 2013 using codes for Ewing sarcoma and primitive neuroectodermal tumors as well as the demographic code for > or = 18 years of age. We selected subjects who were histologically confirmed to have Ewing sarcoma of extraskeletal origin. Imaging features of the primary tumor and metastatic disease were evaluated for lesion location, size, enhancement pattern, necrosis, margin, and invasion of adjacent organs.
RESULTS
Among the 70 patients (mean age, 35.8 +/- 15.6 years; range, 18-67 years) included in our study, primary tumors of EES occurred in the soft tissue and extremities (n = 20), abdomen and pelvis (n = 18), thorax (n = 14), paravertebral space (n = 8), head and neck (n = 6), and an unknown primary site (n = 4). Most primary tumors manifested as large and bulky soft-tissue masses (mean size, 9.0 cm; range, 1.3-23.0 cm), frequently invading adjacent organs (45.6%) and showed heterogeneous enhancement (73.7%), a well-defined (66.7%) margin, and partial necrosis/cystic degeneration (81.9%). Notably, 29 patients had metastatic disease detected at their initial diagnosis. The most frequent site of metastasis was lymph nodes (75.9%), followed by bone (31.0%), lung (20.7%), abdominal solid organs (13.8%), peritoneum (13.8%), pleura (6.9%), and brain (3.4%).
CONCLUSION
Primary tumors of EES can occur anywhere and mostly manifest as large and bulky, soft-tissue masses. Lymph nodes are the most frequent metastasis sites.

Keyword

Ewing sarcoma family of tumors; Extraskeletal Ewing sarcoma; Computed tomography; Imaging

MeSH Terms

Adolescent
Adult
Aged
Asian Continental Ancestry Group
Bone Neoplasms/*pathology/radiography
Brain Neoplasms/pathology/radiography
Female
Humans
Lymph Nodes/pathology
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Metastasis
Neuroectodermal Tumors, Primitive/pathology/radiography
Positron-Emission Tomography
Sarcoma, Ewing/*pathology/radiography
Tomography, X-Ray Computed
Young Adult
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