title: Delayed diagnosis of Ewing's sarcoma of the right humerus initially treated as chronic osteomyelitis: a case report.
abstract: We report a case of limited stage Ewing's sarcoma which was initially treated as chronic osteomyelitis for 3 years. A 24-year-old man presented with a one-week history of pain in the right arm and fever, with histology suggestive of osteomyelitis of the affected humerus. He developed multiple relapses of pain and fever; each episode responded to antibiotic treatment. A second biopsy was performed 3 years later and confirmed a diagnosis of Ewing's sarcoma. Despite a 3-year delay in diagnosis, the disease remained localised. This case report highlights an atypical facet of the natural history of Ewing's sarcoma: a response to antibiotic and anti-inflammatory agents, and the limited stage of the disease despite a misdiagnosis of 3 years. This suggests the possibility that anti-inflammatory agents exert an inhibitory effect on the tumour growth. We also highlight the newer histologic and immunologic staining used in the diagnosis of Ewing's sarcoma.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: B P B
authors.initials: BP
authors.lastname: Tow
authors.forename: M H
authors.initials: MH
authors.lastname: Tan
mesh_terms: D000071443:12E7 Antigen; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015703:Antigens, CD / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000601:surgery; D015815:Cell Adhesion Molecules / Q000032:analysis; D002908:Chronic Disease; D003951:Diagnostic Errors; D005360:Fibula / Q000637:transplantation; D006801:Humans; D006811:Humerus; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010019:Osteomyelitis / Q000175:diagnosis / Q000628:therapy; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors
chemical_list: D000071443:12E7 Antigen; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D015703:Antigens, CD; D014408:Biomarkers, Tumor; C061828:CD99 protein, human; D015815:Cell Adhesion Molecules