Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
J Med Case Rep. 2024 Jul 29;18(1):346. doi: 10.1186/s13256-024-04670-5.
Ewing's sarcoma is a primary bone tumor predominantly observed in children and adolescents, necessitating a multidisciplinary treatment approach. While localized cases have a 5-year survival rate of 60-70%, the prognosis is significantly worse in pelvic advanced cases with metastasis. Moreover, pelvic Ewing's sarcoma has the unique problem of leading to high rates of postoperative infection.
We present the case of a Japanese 14-year-old boy with left iliac Ewing's sarcoma and multiple metastases. At the initial visit, imaging revealed a large tumor in the left iliac bone with extraosseous extension and metastasis to multiple sites. Neoadjuvant chemotherapy resulted in significant tumor reduction. Surgical resection was performed without pelvic ring reconstruction to enable early postoperative chemotherapy and minimize postoperative infection risk. Despite complete abductor muscle removal, the patient achieved a stable gait postoperatively by centering the load axis.
Our case highlights the successful management of a left iliac Ewing's sarcoma with multiple metastases, with a focus on functional preservation and infection risk reduction. Pelvic ring reconstruction was not performed to avoid postoperative complications, emphasizing the importance of early postoperative chemotherapy. The patient achieved a stable gait postoperatively, demonstrating the potential benefits of this approach in similar cases.
尤因肉瘤是一种主要发生在儿童和青少年的原发性骨肿瘤，需要采用多学科治疗方法。局限性病例的 5 年生存率为 60-70%，但有转移的骨盆晚期病例的预后明显较差。此外，骨盆尤因肉瘤存在导致术后感染率高的独特问题。
我们报告了一例日本 14 岁男孩左髂尤因肉瘤和多处转移的病例。初诊时，影像学显示左髂骨有一个大肿瘤，伴有骨外延伸和多处转移。新辅助化疗导致肿瘤明显缩小。为了能够尽早进行术后化疗并降低术后感染风险，我们进行了手术切除，但未进行骨盆环重建。尽管外展肌被完全切除，但患者术后通过将负荷轴中心化，实现了稳定的步态。
我们的病例强调了成功管理左髂尤因肉瘤伴多处转移的方法，重点是功能保存和降低感染风险。未进行骨盆环重建以避免术后并发症，强调了早期术后化疗的重要性。患者术后步态稳定，表明这种方法在类似病例中具有潜在的益处。
