Metastatic Ewing cell sarcoma of the sinus and osteoid osteoma of the orbit.

PURPOSE

To familiarize ophthalmologists with the management of a "solitary hot lesion" on bone scan as part of a metastatic examination.

METHODS

Case report of a 27-year-old man with primary Ewing sarcoma of the fibula. Bone scan as part of a metastatic evaluation showed increased uptake in the left orbit. A metastatic lesion could not be ruled out radiologically.

RESULTS

A biopsy was performed, and the lesion was found to be osteoid osteoma; therefore, the patient received only local radiation therapy to the fibula. Eight months later, the patient developed metastatic Ewing cell sarcoma of the sphenoid sinus and subsequently died.

CONCLUSIONS

Because of the high sensitivity but low specificity of bone scan, secondary lesions on bone scan are not necessarily metastases. A biopsy specimen is often required for pathologic diagnosis.