History and Physical Examination

History

Patient history includes the following:

Patients usually present with pain
Patients often have a palpable mass
Back pain may indicate a paraspinal, retroperitoneal, or deep pelvic tumor
Systemic symptoms of fever and weight loss can also occur and often indicate metastatic disease

Physical examination

Ewing sarcoma can occur in virtually any location. Careful examination of painful sites with inspection and palpation is critical.

Because patients can present with disease close to bone, tumors can result in neuropathic pain. Therefore, a comprehensive neurologic examination to evaluate asymmetrical weakness, numbness, or pain is critical. Patients with lesions of the long bones can present with a pathologic fracture

Clinically significant bone marrow metastases can result in petechiae or purpura due to thrombocytopenia, while patients with lung metastases can present with asymmetrical breath sounds, pleural signs, or rales.

Differential Diagnoses

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Cotterill SJ, Ahrens S, Paulussen M, Jürgens HF, Voûte PA, Gadner H, et al. Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group. J Clin Oncol. 2000 Sep. 18(17):3108-14. [QxMD MEDLINE Link].
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Media Gallery

Radiograph of an 11-year-old boy with a large Ewing sarcoma in the right pelvic area. Destruction of the bone structure resulted from tumor involvement.

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Author

Jeffrey A Toretsky, MD Associate Professor, Departments of Oncology and Pediatrics, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine

Disclosure: Received ownership interest from TDP Biotherapeutics for board membership.

Coauthor(s)

Aerang Kim, MD, PhD Assistant Professor, Department of Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Physician, Center for Cancer and Blood Disorders, Division of Oncology, Children's National Medical Center

Aerang Kim, MD, PhD is a member of the following medical societies: Children's Oncology Group, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Vikramjit S Kanwar, MBBS, MBA, MRCP(UK) Professor Emeritus of Pediatrics, Albany Medical College; Chief of Pediatric Oncology, Homi Bhabha Cancer Hospital, Varanasi, India

Vikramjit S Kanwar, MBBS, MBA, MRCP(UK) is a member of the following medical societies: Children's Oncology Group, Indian Academy of Pediatrics, International Society of Pediatric Oncology

Disclosure: Nothing to disclose.

Acknowledgements

Timothy P Cripe, MD, PhD Professor of Pediatrics, Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center; Clinical Director, Musculoskeletal Tumor Program, Co-Medical Director, Office for Clinical and Translational Research, Cincinnati Children's Hospital Medical Center; Director of Pilot and Collaborative Clinical and Translational Studies Core, Center for Clinical and Translational Science and Training, University of Cincinnati College of Medicine

Timothy P Cripe, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose

Samuel Gross, MD Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.