Long-term follow-up of 15 patients with non-metastatic Ewing's sarcoma and a skip lesion.
BACKGROUND Skip lesions in Ewing's sarcoma of the bone seem to be rare; to our knowledge only 7 cases have been published in the English medical literature.


METHODS
We retrospectively reviewed imaging and histological data relating to 235 patients with non-metastatic Ewing's sarcoma of the bone who participated in the cooperative Ewing's sarcoma study (CESS 86 and CESS 91), and we identified 15 patients with a skip lesion at diagnosis.


RESULTS
The skip lesion was located in the same bone as the primary tumor in 13 patients, and in an adjacent juxtaarticular bone in 2 cases. The average follow-up was 11 years. Despite aggressive treatment including surgery in all cases, tumor relapse occurred in 9 patients, and 7 of these patients died due to metastatic disease.


CONCLUSIONS
Skip lesions in patients with otherwise non-metastatic skeletal Ewing's sarcoma may be of the same consequence as the molecular detection of marrow metastases and possibly confer a worse prognosis. Newer imaging modalities (for example PET) and careful staging work-up may indicate that skip metastases in Ewing's sarcoma are more common than previously suspected.
Department of Orthopaedic Surgery, Vrije Universiteit Medical Centre, Amsterdam. tim.jiya@wanadoo.nl
Timothy U
TU
Jiya
Paul I J M
PI
Wuisman
D000293:Adolescent; D000328:Adult; D000818:Animals; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000175:diagnosis / Q000556:secondary / Q000601:surgery