title: Metastatic Ewing cell sarcoma of the sinus and osteoid osteoma of the orbit.
abstract: OBJECTIVE
  To familiarize ophthalmologists with the management of a "solitary hot lesion" on bone scan as part of a metastatic examination.
  
  
  METHODS
  Case report of a 27-year-old man with primary Ewing sarcoma of the fibula. Bone scan as part of a metastatic evaluation showed increased uptake in the left orbit. A metastatic lesion could not be ruled out radiologically.
  
  
  RESULTS
  A biopsy was performed, and the lesion was found to be osteoid osteoma; therefore, the patient received only local radiation therapy to the fibula. Eight months later, the patient developed metastatic Ewing cell sarcoma of the sphenoid sinus and subsequently died.
  
  
  CONCLUSIONS
  Because of the high sensitivity but low specificity of bone scan, secondary lesions on bone scan are not necessarily metastases. A biopsy specimen is often required for pathologic diagnosis.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
authors.forename: E W
authors.initials: EW
authors.lastname: Chynn
authors.forename: P A
authors.initials: PA
authors.lastname: Rubin
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy; D003937:Diagnosis, Differential; D005360:Fibula; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D010017:Osteoma, Osteoid / Q000000981:diagnostic imaging / Q000473:pathology*; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D010710:Phosphates; D011877:Radionuclide Imaging; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging / Q000556:secondary*; D013101:Sphenoid Sinus; D017556:Technetium Compounds; D014057:Tomography, X-Ray Computed
chemical_list: D010710:Phosphates; D017556:Technetium Compounds; C046451:technetium Tc 99m phosphate