PMC10487117_01
US images of a seven-year-old boy with pelvic extraosseous Ewing's sarcoma. Image (A) shows low echogenicity pelvic soft tissue mass. Image (B) shows several solid nodular hepatic lesions with a bull's-eye appearance suggestive of liver metastases.
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F1
Ultrasound (US) revealed a heterogeneous mass of low echogenicity (Figure 1A) as well as several solid nodular hepatic lesions with a bull's-eye appearance suggestive of metastases (Figure 1B).
Sagittal CT image (A) shows a large mass with heterogeneous enhancement in the portal phase measuring 10 cm in maximum diameter, occupying almost the entire pelvis and extending up to L4-L5. Sagittal T2-weighted MRI (B) shows a large pelvic mass that correlates with the CT image. Axial CT image (C) confirms liver metastases.
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F2
Contrast-enhanced computed tomography (CECT) scan confirmed the presence of this large mass with heterogeneous enhancement in the portal phase measuring 10 cm in maximum diameter and occupying almost the entire pelvis and extending up to L4-L5 (Figure 2A). CECT confirmed also liver metastasis (Figure 2C). Sagittal T2-weighted magnetic resonance imaging (MRI) correlated well with the computed tomography (CT) findings (Figure 2B).
Axial T1-weighted MRI image (A) shows a well-defined, heterogeneous low signal intensity and lobulated pelvic mass with focal hyperintensies indicating hemorrhagic zones. Axial T2-weighted image (B) shows a hyperintense and heterogeneous content.
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F3
MRI showed a large, well-defined, lobulated and heterogeneous pelvic mass hypointense on T1 with persisting focal hyperintensies when fat is saturated, suggesting hemorrhagic areas (Figure 3A). On T2-weighted images, the mass showed hyperintense and heterogeneous content (Figure 3B).
Coronal T2-weighted MRI image (A) shows bladder compression. Axial T2-weighted MRI image (B) shows multiple hepatic metastases with central necrosis.
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F4
The bladder was compressed, which explains the urinary symptoms (Figure 4A). MRI also confirmed hepatic metastases with central necrosis (Figure 4B).