Ewing's Sarcoma: Its Roentgen Classification and Diagnosis

Abstract

In 1921, James Ewing identified a form of primary malignant bone tumor which he designated “diffuse endothelioma” or “endothelial myeloma” (7). This lesion is commonly known today as Ewing's sarcoma or Ewing's tumor. While the clinical and pathological aspects have been amply stressed in a number of reports covering large series of cases (4, 5, 14, 15, 21), the literature on roentgen diagnosis (1, 10, 11, 13, 16, 18, 20) is relatively incomplete; there is no study based on a sufficient volume of dependably proved material with x-ray diagnosis as the primary object. Much of the writing pertaining to the roentgen aspects has been done by those not fully oriented in this specialty. Furthermore, since the pathological identification of this lesion may be extremely difficult, some of the cases upon which discussion of x-ray diagnosis has been based are open to question. Material After careful scrutiny, 111 cases of Ewing's sarcoma from the files of Memorial Center (New York) were considered satisfactory for the present investigation. These were selected on the basis of adequate roentgen coverage, dependability of histologic diagnosis, and clinical correlation. The histologic proof was furnished by Drs. James Ewing, Fred Stewart, or members of their staff in the Department of Pathology. As far as we know, this is by far the largest single series of Ewing's sarcoma studied on the basis of roentgen diagnosis alone. The group was composed of 77 males and 34 females. The male preponderance, approximately 2 to 1, is in keeping with the ratio found in other series. The age distribution by decades is as follows: 29 cases up to the age of nine, 47 between the ages of ten and nineteen, 30 between twenty and thirty, and 5 from thirty years on. Of the 29 patients below ten years of age, only 4 were under two. The tumor is known to be rare among infants and older adults; it is found primarily in adolescence, with the highest incidence between ten and nineteen years. The average age in this series was fifteen years, the youngest patient was seven months, and the oldest was thirty-six years. No example of a primary tumor in the skull, mandible, or vertebra was encountered, although a few such cases have been reported in the literature (14). Metastases, however, were found in all parts of the skeleton. The skeletal distribution of the 111 cases is as follows: Roentgen Diagnosis It was deemed necessary, in this study, to divide the tumors into two main groups. On the basis of their skeletal location, they were separated into those in the long bones and those in the remainder of the skeleton. The long-bone neoplasms were further subdivided according to the particular part of the bone involved. The reason for this was the resemblance in roentgen characteristics which was found among tumors of similar location.