A Clinicopathological Study of Ewing’s Sarcoma/PNET experience from a Tertiary Cancer Centre in North East India

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 21-24 | Jagannath Dev Sharma, Argha Baruah, Anupam Sarma, Lopa Mudra Kakoti, Nizara Baishya, Shiraj Ahmed. DOI: 10.13107/jbst.2020.v06i02.27

Author: Jagannath Dev Sharma[1], Argha Baruah[1], Anupam Sarma[1], Lopa Mudra Kakoti[1], Nizara Baishya[1], [2], Shiraj Ahmed[1]

[1]Department of Pathology, Dr.B.Borooah Cancer Institute, Guwahati, Assam, India.
[2]Department of Hospital based Cancer registry, Dr.B. Borooah Cancer Institute, Guwahati, Assam.

Address of Correspondence
Dr. Argha Baruah,
Department of Pathology, Dr.B.Borooah Cancer Institute,Guwahati-781028, Assam, India.


Introduction: Ewing sarcoma (ES)/PNET is an aggressive malignant tumor with small round cell morphology affecting mainly children and adolescents. The aim of this study was to study the clinicopathological parameters and immunohistochemical panel of skeletal and extraskeletal ES and to correlate with overall survival.
Case Report: Medical files of 70 patients with ES treated at our center between 2009 and 2015 were retrospectively evaluated. The clinico pathological parameters were extracted and statistically correlated with overall survival(OS). Among 70cases of ES ,41 cases were males and 29 cases were females. Most common age group was 10–20 years. Skeletal involvement was seen in 45 cases(64.2%) and 25cases (35.8%) were extraskeletal. The most common skeletal sites of involvement was lower extremity involving  the Femur (24%) and the most common extraskeletal site involved in our study was sinonasal area(5.7%), followed by chestwall, thigh, orbital, calf, gluteal, kidney, and vulva. Two cases showed involvement of the central nervous system(CNS) involving pineal gland and the ventricle. Two cases showed multiple sites of involvement both including chest wall and thigh. Twenty-nine cases(41.4%) showed metastasized disease. The most common site of metastasis was lung followed by bone and brain. Recurrence was seen in 14 cases(20%). Overall 5-year survival was 24%. There was statistically significant correlation found between tumor size (≥8cm) and 5year survival. Furthermore, significant correlation was found between metastasis and 5-year survival.
Conclusion: ES is an aggressive tumor involving skeletal and extraskeletal sites affecting commonly young people, with a poor prognosis for patients with maximum diameter ≥8cm. Metastasisis common in ES and is also a poor prognostic factor.
Keywords: Ewing’sarcoma, skeletal, extraskeletal, survival, metastasis.

1. Paulssen M, Ahrens S, Dunst J, Winkelmann W, Exner GU, Kotz R, et al. Localized Ewing tumor of bone: Final results of the cooperative Ewing’s sarcoma study CESS 86. J Clin Oncol 2001;19:1818-29.
2. Ewing J. Diffuse endothelioma of bone. Proc N Y Path Soc 1921;7:17-24.
3. Angervall L, Enzinger FM. Extraskeletal neoplasm resembling Ewing’s sarcoma. J Cancer 1975;36:240-51.
4. Askin FB, Rosai J, Sibley RK, Dehner LP, McAlister WH. Malignant small cell tumor of the thoracopulmonary region in childhood: A distinctive clinicopathologic entity of uncertain histogenesis. J Cancer 1979;43:2438-51.
5. Bellan DG, Filho RJ, Garcia JG, de Toledo Petrilli M, Viola DC, Schoedl MF, et al. Ewing’s sarcoma: Epidemiology and prognosis for patients treated at the pediatric oncology institute, IOP-GRAACC-UNIFESP. Rev Bras Ortop 2015;47:446-50.
6. Akhavan A, Binesh F, Shamshiri H, Ghanadi F. Survival of patients with Ewing’s sarcoma in Yazd-Iran. Asian Pac J Cancer Prev 2014;15:4861-4.
7. Biswas B, Rastogi S, Khan SA, Mohanti BK, Sharma DN, Sharma MC, et al. Outcomes and prognostic factors for Ewing-family tumors of the extremities. J Bone Joint Surg Am 2014;96:841-9.
8. Lee JA, Kim DH, Lim JS, Koh JS, Kim MS, Kong CB, et al. Soft-tissue Ewing sarcoma in a low-incidence population: Comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Jpn J Clin Oncol 2010;40:1060-7.
9. Worch J, Matthay KK, Neuhaus J, Goldsby R, DuBois SG. Ethnic and racial differences in patients with Ewing sarcoma. J Cancer 2010;116:983-8.
10. Louati S, Senhaji N, Chbani L, Bennis S. EWSR1 rearrangement and CD99 expression as diagnostic biomarkers for Ewing/PNET sarcomas in a Moroccan population. Dis Markers 2018;2018:7971019.
11. Folpe AL, Hill CE, Parham DM, O’Shea PA, Weiss SW. Immunohistochemical detection of FLI-1 protein expression: A study of 132 round cell tumors with emphasis on CD99-positive mimics of Ewing’s sarcoma/primitive neuroectodermal tumor. Am J Surg Pathol 2000;24:1657-62.
12. Rossi S, Orvieto E, Furlanetto A, Laurino L, Ninfo V, Dei Tos AP. Utility of the immunohistochemical detection of FLI-1 expression in round cell and vascular neoplasm using a monoclonal antibody. Mod Pathol 2004;17:547-52.
13. Ahmed SH, Rahman NA, Meng L. Cytokeratin immunoreactivity in Ewing sarcoma/primitive neuroectodermal tumour. Malays J Pathol 2013;35:139-45.
14. Lucas DR, Bentley G, Dan ME, Tabaczka P, Poulik JM, Mott MP. Ewing sarcoma vs lymphoblastic lymphoma. A comparative immunohistochemical study. Am J Clin Pathol 2001;115:11-7.
15. Machado I, Noguera R, Pellin A, Lopez-Guerrero JA, Piqueras M, Navarro S, et al. Molecular diagnosis of Ewing sarcoma family of tumors: A comparative analysis of 560 cases with FISH and RT-PCR. Diagn Mol Pathol 2009;18:189-99.
16. Tirode F, Surdez D, Ma X, Parker M, Le Deley MC, Bahrami A, et al. Genomic landscape of Ewing sarcoma defines an aggressive subtype with co-association of STAG2 and TP53 mutations. Cancer Discov 2015;4:1342-53.
17. Stahl M, Ranft A, Paulussen M, Bölling T, Vieth V, Bielack S, et al. Risk of recurrence and survival after relapse in patients with Ewing sarcoma. Pediatr Blood Cancer 2011;57:549-53.
18. Obata H, Ueda T, Kawai A, Ishii T, Ozaki T, Abe S, et al. Clinical outcome of patients with Ewing sarcoma family of tumors of bone in Japan: The Japanese musculoskeletal oncology group cooperative study. J Cancer 2007;109:767-75.
19. Oksuz DC, Tural D, Dincbas FO, Dervisoglu S, Turna H, Hiz M, et al. Non-metastatic Ewing’s sarcoma family of tumors of bone in adolescents and adults: Prognostic factors and clinical outcome-single institution results. Tumor J 2014;100:452-8.
20. El Weshi A, Allam A, Ajarim D, Al Dayel F, Pant R, Bazarbashi S, et al. Extraskeletal Ewing’s sarcoma family of tumours in adults: Analysis of 57 patients from a single institution. Clin Oncol 2010;22:374-81.
21. Pradhan A, Grimer RJ, Spooner D, Peake D, Carter SR, Tillman RM, et al. Oncological outcomes of patients with Ewing’s sarcoma: Is there a difference between skeletal and extra-skeletal Ewing’s sarcoma? J Bone Joint Surg Br 2011;93:531-6.
22. Bosma SE, Ayu O, Dijkstra PD, Fiocco M, Gelderblom H. Prognostic factors for survival in Ewing sarcoma: A systematic review. Surg Oncol 2018;27:603-10.

How to Cite this article: Sharma JD, Baruah A, Sarma A, Kakoti LM, Baishya N, Ahmed S | A Clinicopathological Study of Ewing’s Sarcoma/PNET experience from a Tertiary Cancer Centre in North East India | Journal of  Bone and Soft Tissue Tumors | May-August 2020; 6(2): 21-24.

[Full Text HTML] [Full Text PDF] [XML]

Diagnostic Comparison of F-18 Sodium FluorideNaF, Bone Scintigraphy, and F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Detection of Bone Metastasis

Vol 5 | Issue 1 | Jan-April 2019 | page: 9-12 | Zehra PınarP Koç, Pelin Ö Kara, Emel Sezer, Vehbi Erçolak

Authors: Zehra PınarP Koç [1], Pelin Ö Kara [1], Emel Sezer [2], Vehbi Erçolak [2]

[1] Department of Nuclear Medicine, Mersin University, Mersin/, Turkey.,
[2] Department of Oncology, Mersin University, Mersin, Turkey. Mersin/Turkey.

Address of Correspondence
Dr. Zehra PınarP ınar Koç,
Mersin University Nuclear Medicine Dpt., Mersin – 33343, Turkey.


Objective: The aim of this study is to compare the diagnostic efficiency of bone scintigraphy, fluorodeoxyglucose (FDG), and sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) in the evaluation of bone metastasis of the several malignant tumors.
Materials and Methods: A total of Thirteen13 patients (9nine Ffemales and, 4four Mmales; mean 62,.3 ± 7,.1 years) with diagnosis of different malignant tumors were included in the study. The comparison of bone scintigraphy, FDG, and NaF PET/CT results were was performed retrospectively.
Results: The NaF PET/CT demonstrated all the metastatic patients in this series; however, FDG PET/CT missed 7/13 and bone scintigrapyhy 1/13 of the patients with bone metastasis. NaF PET/CT showed significantly higher number of metastatic lesions in all the patients.
Conclusion: The lesion- based analysis showed that NaF PET/CT is significantly superior to FDG PET/CT and bone scintigraphy and patient- based analysis lower detection rate for the FDG PET/CT.
Keywords: Bone, scintigraphy, metastasis, sodium fluorideNaF, fluorodeoxyglucosefdg.


1. Tarnawska-Pierścińska M, Hołody Ł, Braziewicz J, Królicki L. Bone metastases diagnosis possibilities in studies with the use of 18F-NaF and 18F-FDG. Nucl Med Rev Cent East Eur 2011;14:105-8.
2. Sampath SC, Sampath SC, Mosci C, Lutz AM, Willmann JK, Mittra ES, et al. Detection of osseous metastasis by 18F-NaF/18F-FDG PET/CT versus CT alone. Clin Nucl Med 2015;40:e173-7.
3. Harisankar CN, Agrawal K, Bhattacharya A, Mittal BR. F-18 fluoro-deoxy-glucose and F-18 sodium fluoride cocktail PET/CT scan in patients with breast cancer having equivocal bone SPECT/CT. Indian J Nucl Med 2014;29:81-6.
4. Roop MJ, Singh B, Singh H, Watts A, Kohli PS, Mittal BR, et al. Incremental value of cocktail 18F-FDG and 18F-NaF PET/CT over 18F-FDG PET/CT alone for characterization of skeletal metastasesin breast cancer. Clin Nucl Med 2017;42:335-40.
5. Chan HP, Hu C, Yu CC, Huang TC, Peng NJ. Added value of using a cocktail of F-18 sodium fluoride and F-18 fluorodeoxyglucose in positron emission tomography/computed tomography for detecting bony metastasis: A case report. Medicine (Baltimore) 2015;94:e687.
6. Iagaru A, Mittra E, Mosci C, Dick DW, Sathekge M, Prakash V, et al. Combined 18F-fluoride and 18F-FDG PET/CT scanning for evaluation of malignancy: Results of an international multicenter trial. J Nucl Med 2013;54:176-83.
7. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. NCCN Clinical Practice Guidelines in Oncology Breast Cancer Version 2; 2016. Available from: [Last accessed on 2016 Oct 19].
8. Yoon SH, Kim KS, Kang SY, Song HS, Jo KS, Choi BH, et al. Usefulness of (18)F-fluoride PET/CT in breast cancer patients with osteosclerotic bone metastases. Nucl Med Mol Imaging 2013;47:27-35.
9. Israel O, Goldberg A, Nachtigal A, Militianu D, Bar-Shalom R, Keidar Z, et al. FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging 2006;33:1280-4.
10. Lapa P, Saraiva T, Silva R, Marques M, Costa G, Lima JP. Superiority of 18F-Fna PET/CT for detecting bone metastases in comparison with other diagnostic ımaging modalities. Acta Med Port 2017;30:53-60.
11. Araz M, Aras G, Küçük ÖN. The role of 18F-NaF PET/CT in metastatic bone disease. J Bone Oncol 2015;4:92-7.
12. Schirrmeister H, Glatting G, Hetzel J, Nüssle K, Arslandemir C, Buck AK. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001;42:1800-4.
13. Piccardo A, Puntoni M, Morbelli S, Massollo M, Bongioanni F, Paparo F, et al. 18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-naF PET/CT. Nuklearmedizin 2015;54:163-72.
14. Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS. Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clin Nucl Med 2013;38:e290-6.
15. Hillner BE, Siegel BA, Hanna L, Duan F, Quinn B, Shields AF. 18F-fluoride PET used for treatment monitoring of systemic cancer therapy: Results from the national oncologic PET registry. J Nucl Med 2015;56:222-8.
16. Iagaru A, Mittra E, Dick DW, Gambhir SS. Prospective evaluation of (99m)Tc MDP scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CTfor detection of skeletal metastases. Mol Imaging Biol 2012;14:252-9.

How to Cite this article: PKoç Z P, Kara P Ö, Sezer E, Erçolak V.Diagnostic Comparison of F-18 Sodium FluorideNaF, Bone Scintigraphy, and F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Detection of Bone Metastasis. Journal of Bone and Soft Tissue Tumors Jan-Apr 2019;5(1): 9-12.


(Abstract    Full Text HTML)   (Download PDF)