Abstract
Ewing sarcoma is a high-grade, malignant neoplasm which often occurs in children and adolescents. It is commonly treated with a combination of chemotherapy, radiation therapy and surgical resection. However, sufficient surgical margin cannot be achieved sometimes because commonly affected sites are the pelvis and the proximal femur. The authors describe a patient with Ewing sarcoma of the pelvis who was treated with internal hemipelvectomy combined with chemotherapy and radiation therapy.
A 14-year-old boy was referred to us for the treatment of pelvic osteomyelitis. Radiographs and computed tomographs showed osteoblastic and osteolytic lesion in the right pelvis, and a pathological fracture of the acetabulum. Magnetic resonance images showed the entire right side of the pelvis was affected. A bone scan showed increased uptake in the same region. Open biopsy revealed a small round cell malignant tumor consistent with Ewing sarcoma.
A course of preoperative chemotherapy diminished the increase of the uptake of the bone scan. Then we undertook total internal hemipelvectomy. Complete removal of the tumor with a sufficient margin was achieved, which included the right hip joint. The osteotomized trochanter was fixed against the sacrum with cancellous screws, and a pedicle screw system connected the lumbar vertebrae and the femoral shaft. The surgery was followed by radiation and chemotherapy.
The patient remained disease free at the two-year follow-up. He could walk with two crutches, although the affected limb was shorter by 8 centimeters.
