Image Findings and Pre-operative Embolization of Pediatric Ewing’s sarcoma of skull: a case report

Reprint requests to: Dr. Feng-Chi Chang Department of Radiology, Taipei Veterans General Hospital. No. 201, Sec. 2, Shih Pai Road, Taipei 11217, Taiwan, R.O.C. Ewing’s sarcoma of the skul l is a rare and aggressive primary bone tumor occurs in youngaged pat ients. The current main therapeut ic strategy is surgical tumor removal followed by adjuvant chemoradiotherapy. We, hereby, present a pediatric case of Ewing’s sarcoma arising from right temporal bone. Pre-operative embolizat ion of the hypervascular tumor fol lowed by immediate surgical resection of the lesion was performed. The surgery resulted in a near-total tumor removal and a small residual tumor at the adjacent meninge. Early recurrence of the small residual tumor developed shortly after the surgery. This short time interval indicated the importance and challenge of complete resection for a malignant tumor of skull. Ewing’s sarcoma is an uncommon pr imary bone tumor of childhood and adolescence, which account for around 10% of malignant bone neoplasm [1]. The most common location is metadiaphysis of long bones, pelvis and ribs. Ewing’s sarcoma of the skull is rare. The classical image findings of Ewing’s sarcoma of skull include large extra-axial tumor with or without bony destruction [2]. Ewing’s sarcomas of skull may present periosteal reaction and usually enhance vividly, suggesting hypervascularity [2]. Currently, the recommended t reatments include radical tumor excision and chemoradiotherapy [3]. However, tumor hypervascularity makes surgery risky and massive bleeding during surgical resection unavoidable. Pre-operative embolization is frequently used to facilitate surgery of hypervascular head and neck tumors [4, 5]. Hereby, we report a case of primary pediatr ic Ewing’s sarcoma of skull t reated with combined preoperative embolization and immediate surgical resection.