PMC6588139_01
Clinical picture of the patient showing a massive, fungating mass over the left upper back.
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F1
On presentation, a huge fungating mass was noticed over the left upper back and shoulder region with active bleeding and foul-smelling discharge from the ulcer (Fig. 1).
T2-weighted magnetic resonance imaging images showing the extent of the lesion. (a) Coronal section, (b) axial section.
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F2
Magnetic resonance imaging of the shoulder and upper back showed a T1 isointense and T2 heterogeneous high-signal intensity lesion which measured 18 cm x27cm x 26cmin size, with multiple fluid levels, degenerative cystic changes, hemorrhage, areas of necrosis, and infiltration of periscapular musculature (Fig. 2).
Histopathological image of the resected specimen (H and E stain, 300x) showing sheets of small, round, uniform cells with fibrous septa and scanty stroma.
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F3
Diagnosis of Ewing's sarcoma was made by histopathological examination of needle biopsy sample from the swelling, which showed sheets of small, round, and uniform cells with scanty cytoplasm, separated by fibrous strands with few mitosis and minimal stroma (Fig. 3).
Plain radiograph of the left shoulder region.
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F4
The humeral head was secured to the lateral end of the clavicle (Fig. 4), and the defect over the back following resection was closed by negative pressure dressing and subsequentlycovered2days later with latissimus dorsi free pedicle flap(Fig. 5).
Gross image of the resected specimen.
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F6
Diagnosis of ES was confirmed by histopathological examination of the resected specimen and all the resected surgical margins were free of tumor (Fig. 6). 3 weeks after surgery, concomitant radiotherapy and adjuvant chemotherapy (6 cycles of vincristine, doxorubicin, and cyclophosphamide alternating with if osfamide and etoposide) were started.
Clinical picture on 15-month follow-up.
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F7
On final follow-up of 3years, the patient showed no signs of local recurrence (LR) or metastasis and had returned to her prior vocational status (Fig. 7).