Ewing sarcoma in calcenous presented as chronic osteomyelitis: a case report and literature review

Abstract

Ewing's sarcoma (ES) is an uncommon primary malignant tumor of the bone, mostly affecting 5-20 years of age with male predominance. It commonly affects the diaphysial region of long bones, while the small bones of hands and feet are extremely rare (3-5%) to be affected. The authors report a case of calcaneal ES which was misdiagnosed as bacterial chronic osteomyelitis and treated inappropriately. A high index of suspicion is required in diagnosing tumors at rare sites to avoid undue delay in initiating appropriate therapy. As the overall prognosis of ES of the calcaneum is lower compared to other sites, these tumors should have an extensive radiological evaluation and histological confirmation, as misdiagnosis and treatment delays will have detrimental outcomes.

Keywords: bone tumor; calcaneal Ewing’s sarcoma; calcaneus; case report; osteomyelitis.

Figure 1

Lateral (a) and anteroposterior (b) views of plain radiography of the left heel showed an expansile sclerotic lesion in the calcaneum with cortical break and periosteal reaction.

Figure 2

On T1-weighted sagital ankle MRI imaging (a), the lesion was seen as low intensity with bone grafts. On T2-weighted imaging (b), the lesion was heterogeneously hyperintense with few foci of blooming in the central and peripheral parts. It showed a significant postcontrast enhancement in these parts too.