J Korean Soc Radiol.  2013 Aug;69(2):99-103. 10.3348/jksr.2013.69.2.99.

Extraskeletal Primary Ewing's Sarcoma in the Nasal Cavity: A Case Report

• Jeong BY
• Park SW
• Kim EJ
• Choi JS
• Lee EJ

• KMID: 2208812
• DOI: http://doi.org/10.3348/jksr.2013.69.2.99

Abstract

Ewing's sarcoma presents a rare tumor of the head and neck, and even rarer in the nasal cavity and/or paranasal sinuses. We report the case of Ewing's sarcoma in the nasal cavity, as presented with nasal obstruction and epistaxis. The CT and MRI examination reveals a mass in the left nasal cavity with extension to contralateral side, ethmoidal sinus, and nasopharynx. We provide an overview of Ewing's sarcoma in the nasal cavity and discuss radiologic findings of this unusual case.

MeSH Terms

Epistaxis
Head
Nasal Cavity
Nasal Obstruction
Nasopharynx
Neck
Paranasal Sinuses
Sarcoma, Ewing

Figure

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  Fig. 1 Initial endoscopic features. A lobulated mass (arrows) coated with discharge was detected in the left nasal cavity expanding to contralateral side.

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  Fig. 2 Ewing's sarcoma in the left nasal cavity in a 42-year-old man. Postcontrast coronal CT image (A) shows an expansile and well-defined soft tissue mass (arrows) in the left nasal cavity with inhomogeneous enhancement. The mass extends to the contralateral nasal cavity, left posterior ethmoid sinus and hard palate. Coronal CT image with bone algorithm (B) demonstrates better bony destructive change. On precontrast coronal T2-weighted image with fat suppression (C), an expansile lobulated mass (arrows) in the left nasal cavity shows hyperintense signal intensity compared with the muscle. Precontrast coronal and axial T1-weighted images with fat suppression (D, E) show slightly hyperintense signal intensity. Postcontrast T1-weighted axial image with fat suppression (F) reveals heterogeneous enhancement of the mass. As seen on CT images, extension to adjacent structures with bony destructive change is also noted.

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  Fig. 3 Pathologic features of Ewing sarcoma/Primitive neuroectodermal tumor. A. The tumor is composed of densely distributed, uniform, small to medium sized, round cells with scanty cytoplasm. Mitotic figures are readily found (Hematoxylin & Eosin, × 400). B. The tumor cells are immunoreactive with FLI-1 protein (Immunohistochemistry, × 400). Note.-FLI-1 = Friend leukemia integration-1

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