Vaginal metastasis of a Ewing Sarcoma five years after resection of the primary tumor

Abstract

A 35-year-old female presented with pain and swelling of the left wrist. A diagnosis of Ewing sarcoma was made and she underwent neoadjuvant chemotherapy and surgery. Macroscopic viable areas remained on the map of the surgical specimen; as such, she was classified as a poor responder and received high dose adjuvant chemotherapy. She remained disease-free for five years, until age 40. A vaginal polyp was then detected during a routine gynaecologic examination. It was removed and histopathology revealed metastatic Ewing sarcoma. To our knowledge, this is the first reported case of a vaginal metastasis of Ewing sarcoma.

Figure 1

Initial evaluation. CT: lytic lesion with partial cortical destruction.

Figure 2

Axial T1W MR image after contrast medium injection: the soft tissue extension is well studied.

Figure 3

Sagital T1W MR image, after contrast medium injection. Medullary and soft tissue extensions are well evaluated.

Figure 4

The metastasis is made of homogeneous small round cells.

Figure 5

Interphase FISH with the EWSR1 (22q12) break-apart probe. Within a single nucleus fused red/green signals mark one intact 22q12 region, whereas split red/green signals indicate the presence of an EWSR1 gene rearrangement.