Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7960-7967
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7960
Resection with limb salvage in an Asian male adolescent with Ewing’s sarcoma: A case report
Chien-Ying Lai, Kuan-Ju Chen, Tsung-Yu Ho, Ling-Yi Li, Chien-Chung Kuo, Hsien-Te Chen, Yi-Chin Fong
Chien-Ying Lai, Kuan-Ju Chen, Tsung-Yu Ho, Ling-Yi Li, Chien-Chung Kuo, Hsien-Te Chen, Yi-Chin Fong, Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404, Taiwan
Chien-Ying Lai, Ling-Yi Li, Hsien-Te Chen, Spine Center, China Medical University Hospital, Taichung 404, Taiwan
Chien-Chung Kuo, Hsien-Te Chen, Yi-Chin Fong, School of Medicine, China Medical University, Taichung 404, Taiwan
Author contributions: Lai CY and Fong YC conceptualized the study; Fong YC supervised the entire study; Lai CY drafted and reviewed the manuscript; all authors have read and approved the final version of the manuscript for submission.
Informed consent statement: The patient and his family agreed to the publication of this case report and provided a signed informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Chin Fong, MD, PhD, Chief Doctor, Professor, Department of Orthopedic Surgery, China Medical University Hospital, No. 2 Yude Road, North District, Taichung 404, Taiwan. d1762@mail.cmuh.org.tw
Received: December 21, 2021
Peer-review started: December 21, 2021
First decision: May 11, 2022
Revised: May 31, 2022
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: August 6, 2022
Processing time: 212 Days and 22 Hours
Abstract
BACKGROUND

Ewing’s sarcoma is a highly malignant primary bone tumor that commonly affects children. For young patients, multidisciplinary treatment and limb salvage are recommended, and surgical plans considering the growth potential and bone activity after tumor resection are essential.

CASE SUMMARY

An 11-year-old Asian boy had a 1-mo history of a right-sided limping gait. Imaging revealed a proximal tumor with bone destruction and physeal involvement over the right femoral neck. He was diagnosed with stage IV (T1N0M1aG3) Ewing’s sarcoma with bilateral lung metastases. Neoadjuvant chemotherapy decreased the tumor size and confined it to the metaphyseal region. The patient underwent four stages of surgery: wide tumor excision plus reconstruction with vascular fibular bone graft plus internal fixation; repeat open reduction and internal fixation; femoral lengthening with orthosis after physeal maturity; and orthosis removal and bone elongation (approximately 6 cm). Following surgery, he could walk without discomfort and had almost equal-sized bilateral femoral heads, indicating physis preservation. The surgery was successful, and normal femoral head growth was achieved after complete remission. The patient was able to resume normal activities with equal length of the bilateral lower limbs.

CONCLUSION

Tumor treatment and reconstruction following resection are important in skeletally immature patients with Ewing’s sarcoma to improve quality of life.

Keywords: Ewing’s sarcoma; Lower limb discrepancy; Orthosis; Vascular fibular graft; Reconstruction; Case report

Core Tip: Ewing’s sarcoma is an uncommon primary malignant bone tumor, and its treatment is a challenge to the orthopedic surgeon. Beyond survival, current treatment also focuses on functional preservation and cosmetic appearance. This 9-year follow-up case illustrates the complete treatment course from resection to reconstruction and rehabilitation for Ewing’s sarcoma, which demonstrates a complete clinical picture for pediatric specialist and pediatric surgeons dealing with complex tumor surgery. The patient not only achieved complete remission, but also had good functional outcomes with limb salvage.