title: Loss of pulp sensitivity and pain as the first symptoms of a Ewing's sarcoma in the right maxillary sinus and alveolar process: report of a case.
abstract: This case report describes the diagnosis and treatment of a Ewing's sarcoma in the right maxillary sinus and alveolar bone of a 19-year-old female patient. The first clinical symptoms were a loss of sensitivity of the premolars and first molar in the right maxilla and acute pain located in the area of these teeth. Initially, the referring dentist had treated these findings as an acute apical periodontitis with root canal medication. Because swellings on the palatal and buccal aspects of the teeth occurred and could not be treated with incision and drainage, the dentist referred the patient. Cone-beam computed tomography revealed a proliferation of soft tissue in the right maxillary sinus, with a radiopaque material at the tip of the mesiobuccal root of the first molar and resorptive signs of the mesiobuccal and distobuccal roots of the first molar. The palatal cortical bone of the right alveolar process seemed to be intact. After explorative surgery with biopsies from the buccal, palatal, and sinus proliferation areas, the pathologist diagnosed the lesion as a Ewing's sarcoma. Treatment of the patient consisted of initial chemotherapy, hemimaxillectomy, and postsurgical chemoradiotherapy.
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland. michael.bornstein@zmk.unibe.ch
authors.forename: Michael M
authors.initials: MM
authors.lastname: Bornstein
authors.forename: Thomas
authors.initials: T
authors.lastname: von Arx
authors.forename: Hans Jörg
authors.initials: HJ
authors.lastname: Altermatt
mesh_terms: D000071443:12E7 Antigen; D016301:Alveolar Bone Loss / Q000209:etiology; D000539:Alveolar Process / Q000473:pathology*; D015703:Antigens, CD / Q000032:analysis; D001641:Bicuspid / Q000473:pathology; D015815:Cell Adhesion Molecules / Q000032:analysis; D054893:Cone-Beam Computed Tomography; D003788:Dental Pulp Diseases / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008441:Maxillary Neoplasms / Q000150:complications*; D008444:Maxillary Sinus Neoplasms / Q000150:complications*; D008963:Molar / Q000473:pathology; D015514:Oncogene Proteins, Fusion / Q000032:analysis; D010146:Pain / Q000209:etiology; D010485:Periapical Periodontitis / Q000175:diagnosis; D051789:Proto-Oncogene Protein c-fli-1; D034802:RNA-Binding Protein EWS; D012512:Sarcoma, Ewing / Q000150:complications*; D014157:Transcription Factors / Q000032:analysis; D014746:Vimentin / Q000032:analysis; D055815:Young Adult
chemical_list: D000071443:12E7 Antigen; D015703:Antigens, CD; C061828:CD99 protein, human; D015815:Cell Adhesion Molecules; C106031:EWS-FLI fusion protein; D015514:Oncogene Proteins, Fusion; D051789:Proto-Oncogene Protein c-fli-1; D034802:RNA-Binding Protein EWS; D014157:Transcription Factors; D014746:Vimentin