Radiographic Appearance of Ewing Sarcoma of the Hands and Feet: Report from the

Review of current data from the Intergroup Ewing Sarcoma Study (lESS) shows that Ewing sarcoma is rare in bones of the hands and feet. The 12 patients from the lESS protocols with hand or foot Ewing sarcoma are comparable to those already reported in the literature. With the exception of lesions in the calcaneus, the prognosis for disease- free survival is excellent. The radiographic features of hand and foot Ewing sarcoma are generally those of classic Ewing sarcoma: permeation, soft-tissue mass, and, often, associated sclerotic reaction. However, with the exception of sclerosis, features sug- gesting bone reaction and slow tumor growth in these patients were distinctly uncommon compared with Ewing sarcoma in general. Those radiographic features suggesting aggressive behavior were slightly more common than in the general Ewing population. Even so, neither the radiographic appearance nor the greatest dimension of the radi- ographic lesion can be shown to contribute significantly to prognostication in these patients. Apparently location of the lesion is important, since in the reported cases in the literature and in this series, lesions of the calcaneus fared poorly. The importance of this set of patients therefore relates to awareness and early recognition of an unusual appearance and location of Ewing sarcoma. Ewing sarcoma, although the second most common primary malignant bone neoplasm of children, occurs only rarely in the bones of the hands and feet (1-1 8). We reviewed patients in the 7299 and 7450 Intergroup Ewing Sarcoma Study (lESS) and identified those whose primary lesions were in either the hands or feet. The analysis of radiographic appearance, clinical findings, and clinical course is presented for the 12 patients with tumor in these locations.