‣Description of Ewing'sSkeletally immatureL - diaphysisA - radioluscencyR - onion skinning, periosteal reaction, wide zoneM - Heterogenous‣Why is Ewing's presentation like an infection?Clinically - fever, pain, swellingBloods - WBC, CRP and ESR elevated‣What is the most common MSTS grading for Ewing?Almost all Ewing's sarcomas fall into stages IIB or III.high grade, extra-compartmentalDiagnosis and Treatment of Ewing's SarcomaRecent years have seen a remarkable change in the perception of the histogenesis and the relationship between skeletal and extra-skeletal Ewing's sarcoma and primitive neuroectodermal tumor (PNET) ( 1). In 1918, Stout reported a case with an ulnar nerve tumor composed of undifferentiated round cells that form rosettes, subsequently defined as PNET of soft tissue ( 2).academic.oup.com‣What special investigation other than the usual in Ewing?Bone marrow biopsy - needed TRO mets to bone marrow‣What is the gene involved in Ewing?11;22 Translocation‣What is the classic histology?CD-99 staining"monotonous small round blue cells"Pseudo-rossettes - circles of cells with necrosis in center‣Management of Ewing's?Neoadjuvant chemo and radioSurgeryAdjuvantGeneral MSO ‣What are poor prognostic factors of Ewing's?Blood tests - Anemia, Raised WBC, Raised LDHImaging - Size > 8cm, pulmonary metsPatient profile - Male, > 14 yoHistology - p53 mutationResponse to chemo - <90% kill rate‣Response to chemo and radio?Sensitive to both!