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Case Reports
. 2018 Aug 31;12(8):17-24.
doi: 10.3941/jrcr.v12i8.3164. eCollection 2018 Aug.

Isolated delayed metastasis to the talus from Ewing's sarcoma

Layla Nasr  1 , Lena Naffaa  1 , Alaeddine El Alayli  1 , Miguel R Abboud  2 , Nabil J Khoury  1
Affiliations
Case Reports

Isolated delayed metastasis to the talus from Ewing's sarcoma

Layla Nasr et al. J Radiol Case Rep. .

Abstract

Bone metastasis to the hands and feet, known as acrometastasis, is a very rare finding and tends to be associated with extensive metastasis. We herein report the case of a 14-year-old girl known to have a history of successfully treated Ewing's sarcoma arising from the ribs, who presented with a pathologically proven isolated metastatic lesion to the talus 7 years after achieving clinical and radiologic remission. We describe the imaging findings on MRI, CT scan and PET-CT. To our knowledge, talar metastasis from Ewing's sarcoma has been previously reported only twice in the English literature. Noteworthy is the fact that one of the previously reported lesions was considered a skip metastasis, and the other was under-described in terms of primary and secondary tumor location and time to metastasis. In addition, the overall imaging findings were rather suggestive of a benign lesion, particularly on CT scan.

Keywords: Bone metastases; CT scan; Ewing Sarcoma; MRI; PET-scan; Talus.

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Figures

Figure 1
Figure 1
8-year-old girl with Ewing’s sarcoma of the right rib. Bone scan utilizing Tc-99m MDP was performed, demonstrating no abnormal uptake outside the right ribs (site of original tumor), in particular in the left talus.
Figure 2
Figure 2
14-year-old girl with metastatic Ewing’s sarcoma to the left talus. Technique: MRI of the left ankle and foot: (A) sagittal T1-weighted (TR=520, TE=20); (B) sagittal short tau inversion recovery (STIR) (TR=6300, TE=60); (C) coronal T1-fat saturation following IV gadolinium administration (TR=520, TE=20). Findings: A lesion is seen involving the head and neck of the talus, showing low signal intensity on T1-weighted (arrow) (A), heterogeneous signal with areas of intermediates and high signal intensity on STIR (arrow) (B). A linear hypo-intensity is noted within the lesion in keeping with thick trabeculae. Significant heterogeneous enhancement following IV contrast injection (C). Mild enhancing bone marrow edema is noted around the tumor in (C) with soft tissue edema surrounding the talus and extending into the sinus tarsi (arrow).
Figure 3
Figure 3
14-year-old girl with metastatic Ewing’s sarcoma to the left talus. Technique: CT scan of the foot in bone window setting: (A) axial and (B) sagittal reconstruction Findings: A lytic lesion with thick trabeculae and sclerotic margins is seen in the mid plantar aspect of the talus (black arrow in B). associated with focal cortical disruption along its dorsal aspect (A) (white arrow).
Figure 4
Figure 4
14-year-old girl with metastatic Ewing’s sarcoma to the left talus. Technique: Pathology: (A) H&E (x40); (B) CD99 immunohistochemistry (x4) Findings: there is An aggregate of small, round, uniform hyperchromatic cells replacing the bone marrow elements (A), Showing positive staining (arrows) (B).
Figure 5
Figure 5
14-year-old girl with metastatic Ewing’s sarcoma to the left talus. Technique: Axial FDG-PET/CT scan Findings: Radiotracer uptake is increased within the left talar tumor. SUV measurements are MAX 2.40 SUV, MEAN 1.72 SUV.
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References

    1. Maheshwari AV, Chiappetta G, Kugler CD, Pitcher JD, Jr, Temple HT. Metastatic skeletal disease of the foot: case reports and literature review. Foot Ankle Int. 2008;29(7):699–710. - PubMed
    1. Granowetter L, Womer R, Devidas M, Krailo M, Wang C, Bernstein M, et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: a Children’s Oncology Group Study. J Clin Oncol. 2009;27(15):2536–41. - PMC - PubMed
    1. Bakotic B, Huvos AG. Tumors of the bones of the feet: the clinicopathologic features of 150 cases. J Foot Ankle Surg. 2001;40(5):277–86. - PubMed
    1. Rybak LD, Rosenthal DI. Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med. 2001;45(1):53–64. - PubMed
    1. Baraga JJ, Amrami KK, Swee RG, Wold L, Unni KK. Radiographic features of Ewing’s sarcoma of the bones of the hands and feet. Skeletal Radiol. 2001;30(3):121–6. - PubMed

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