Rajappa Srinivasan, Menon P Gopinath, Sundaram Sandhya
J Hand Microsurg. 2010 Dec;2(2):82-4. doi: 10.1007/s12593-010-0016-5. Epub 2010 Oct 6.
Ewings sarcoma of the hand is relatively rare. Ewings sarcoma can present with minimal pain and swelling of the affected digit. The Erythrocyte sedimentation rate and C-reactive protein may be high. Radiologically, Ewings sarcoma can present with a plethora of features from permeative bone destruction to expansile lesions with or without periosteal reaction. Because of these features, this can be confused with Tuberculosis especially in a country like ours where Tuberculosis is endemic. This leads to starting of inappropriate treatment and delay in diagnosis. We report a case of an 18 year old boy who was initially diagnosed as Tuberculous dactylytis of the proximal phalanx of the little finger. He was started on anti-tuberculous treatment and did not respond to it. Subsequent investigation in our centre which also included an open biopsy, confirmed the diagnosis of Ewings sarcoma. He was treated with ray excision, and chemotherapy. This case is being presented for its rarity and also to emphasize the fact that an open biopsy in suspected cases would be appropriate to confirm the diagnosis. This would prevent delay in diagnosis of rare conditions like Ewings sarcoma.
手部尤因肉瘤相对少见。尤因肉瘤可表现为患指轻微疼痛和肿胀。红细胞沉降率和C反应蛋白可能升高。在放射学上，尤因肉瘤可呈现多种特征，从浸润性骨质破坏到有或无骨膜反应的膨胀性病变。由于这些特征，其可能与结核病混淆，尤其是在像我们这样结核病流行的国家。这会导致开始不恰当的治疗并延误诊断。我们报告一例18岁男孩，最初被诊断为小指近节指骨结核性指炎。他开始接受抗结核治疗，但无反应。我们中心随后的检查，包括开放活检，确诊为尤因肉瘤。他接受了射线切除和化疗。展示该病例是因其罕见性，同时也为强调在疑似病例中进行开放活检以确诊是合适的。这将防止延误尤因肉瘤等罕见疾病的诊断。
