PMC2940167_01
Clinical photograph showing massive scapular swelling
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On clinical examination, the shoulder girdle swelling was diffuse with ill-defined margins, firm to hard in consistency with tense and shiny over lying skin [Figure 1].
Clinical photograph showing skull vault swelling in the frontoparietal region
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Scalp swelling was present in frontoparietal region, which was hard in consistency and tender [Figure 2].
Pre-treatment radiograph of right shoulder showing a sclerotic lesion of scapula with loss of definition of margins of scapula and soft tissue mass
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At the time of presentation, plain radiograph of the affected shoulder showed a sclerotic lesion of scapula with loss of definition of margins of scapula with soft tissue mass [Figure 3].
Lateral radiograph of skull vault showing an osteolytic lesion with erosion of inner and outer tables associated with sutural diastasis and periosteal reaction
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Lateral radiograph of skull showed osteolysis with erosion of inner and outer table associated with sutural diastasis and periosteal reaction [Figure 4].
FNAC from scapular mass was consistent with small round cell tumor of childhood - Ewing's sarcoma. (a) Photomicrograph showing loose clusters and the discrete cell population of monomorphic, round cells with scant cytoplasm, slightly irregular nuclei, and occasional pseudo-rosette and focal necrosis. Note that a mixture of two types of cell population - small and large - can be appreciated, one of the criteria for diagnosis of Ewing's sarcoma (H and E stain). (b) Photomicrograph focused to show rosette like structure formation, as occasionally seen in cases of Ewing's sarcoma (H and E stain). (c) Photomicrograph showing PAS positivity in few viable cells (PAS stain)
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FNAC from the scapular and scalp swelling was consistent with malignant small round cell tumor - Ewing's sarcoma [Figure 5].
Clinical photograph showing significantly reduced scapular swelling (post treatment)
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The patient showed dramatic response to chemoradiation therapy both clinically and radiologically [Figures 6 and 7].
Radiograph of right shoulder showing extensive sclerosis of the lesion after chemoradiation
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The patient showed dramatic response to chemoradiation therapy both clinically and radiologically [Figures 6 and 7].
Post-treatment lateral radiograph of skull vault showing sclerosis in and around the lesion. The sclerosis seems to be bridging the diastasis
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The post-treatment lateral radiograph of skull showed development of sclerosis in and around the lesion [Figure 8].