Ewing's sarcoma as second malignant neoplasm after retinoblastoma: a case report.
OBJECTIVE
To report a case of a child with the hereditary form of unilateral retinoblastoma (RB), who developed Ewing's sarcoma of the right fibula 3 years after the enucleation of the right eye.


METHODS
The child was diagnosed as a case of RB of the right eye at the age of 9 months. He was fully investigated and found to have locally advanced RB with bone marrow involvement (Reese-Ellsworth stage IVA). Enucleation was recommended to the family, but they refused. The patient received chemotherapy and diode laser thermotherapy in Kuwait and the UK. He had a local relapse after 11 months and subsequently underwent enucleation of the right eye. After 3 years, he was investigated for a small swelling in his right lower leg. After extensive investigations, it was reported as Ewing's sarcoma. He was treated with chemotherapy, surgery (complete excision of the fibula) and high-dose chemotherapy followed by autologous stem cell transplantation. The child is now nearly 2 years after completing the treatment and is disease free.


CONCLUSIONS
This case confirms the increased risk of a second malignant neoplasm (SMN) in children with hereditary RB. These children need a very close follow-up for the early diagnosis of SMNs or even subsequent malignancies.
Mittal
Rakesh
R
Department of Medical Oncology, Hussain Maki Al Juma Centre for Specialized Surgeries, Kuwait. rakeshmittal55@hotmail.com
Al Awadi
Shafika
S
Sahar
Omar
O
Behbehani
A M
AM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000628:therapy; D002675:Child, Preschool; D003937:Diagnosis, Differential; D015353:Eye Enucleation; D005360:Fibula / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000628:therapy; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012175:Retinoblastoma / Q000175:diagnosis* / Q000628:therapy; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000628:therapy; D033581:Stem Cell Transplantation; D016896:Treatment Outcome