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. 2025 Jan 2;15(1):939-946.
doi: 10.21037/qims-24-963. Epub 2024 Dec 18.

Radiological findings in children with primary mediastinal Ewing sarcoma/primitive neuroectodermal tumors: a retrospective case series study

Rui Wang  1 , Shuyi Liu  1 , Yu Wu  1 , Mingjie Zhang  1
Affiliations

Radiological findings in children with primary mediastinal Ewing sarcoma/primitive neuroectodermal tumors: a retrospective case series study

Rui Wang et al. Quant Imaging Med Surg. .

Abstract

The goal of this study was to summarize the radiological findings and clinical characteristics of mediastinal Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) in children. A retrospective review was conducted on the clinical and imaging data of 6 children with primary mediastinal ES/PNET that was confirmed by pathology. There were 3 girls and 3 boys in this study, aged between 2 and 11 years old. The tumors exhibited a range of maximum diameters for each child, spanning from 3.8 to 16.0 cm, and the boundaries of 6 tumors were unclear. Furthermore, the tumors were located in the posterior mediastinum in 2 cases, in the mid-posterior mediastinum in 3 cases, and in the anterior middle posterior mediastinum in 1 case. Necrosis and cystic degeneration were found in all 6 cases, and calcification was found in 2 cases, and the solid part of the tumors showed moderate heterogeneous progressive enhancement. The spinal epidural was involved in 2 cases; adjacent ribs were invaded in 2 cases; the adjacent vertebral body and appendage were invaded in 1 case, and the chest wall was invaded in 4 cases. Finally, pleural effusion occurred in 4 cases, including 1 case with pericardial effusion; 3 patients with pleural metastasis. In conclusion, the computed tomography (CT) findings of primary ES/PNET originating in childhood show a level of distinctiveness that facilitates their identification.

Keywords: Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET); computed tomography (CT); mediastinum; pediatric radiology.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-963/coif). All authors report the funding from General Guidance Project of Guangzhou Health Science and Technology Project (No. 20231A011036). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
A 10-year-old girl with right posterior mediastinal ES/PNET. Enhanced CT shows that the lesion is oval and heterogeneously enhanced; the lesion also involved the adjacent right erector spinae muscle. ES/PNET, Ewing sarcoma/primitive neuroectodermal tumors; CT, computed tomography.
Figure 2
Figure 2
A 2-year-old girl with mid-posterior mediastinal ES/PNET. (A) Plain CT shows a soft tissue mass in the mid-posterior mediastinal region with bone destruction in the adjacent ribs. (B) Enhanced CT shows markedly heterogeneous enhancement; the lesion entered the spinal canal through the intervertebral foramen (red arrow), and the left posterior back erector spinae muscle was involved. ES/PNET, Ewing sarcoma/primitive neuroectodermal tumors; CT, computed tomography.
Figure 3
Figure 3
An 11-year-old boy with middle and posterior mediastinum ES/PNET. (A) Plain CT shows mass calcification in the lesion, a large amount of pleural effusion on the right side, and multiple metastatic lesions in the pleura. (B) Enhanced CT shows obvious uneven enhancement and homogeneous enhancement of metastatic lesions in the pleura (red arrows). ES/PNET, Ewing sarcoma/primitive neuroectodermal tumors; CT, computed tomography.
Figure 4
Figure 4
An 11-year-old boy with middle and posterior mediastinum ES/PNET. (A) Plain CT shows necrosis, cystic degeneration, and patchy hemorrhage in the lesion, and the volume of the left lung was reduced by compression. (B) The tumor shows uneven and obvious enhancement. (C) H&E staining (×100) shows the presence of small, round tumor cells arranged in compact nests and rosette-shaped clusters. These tumor cells exhibited reduced cytoplasmic content and displayed a pale nuclear stain. ES/PNET, Ewing sarcoma/primitive neuroectodermal tumors; CT, computed tomography; H&E, hematoxylin eosin staining.
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