Author(s): Rahul Parmar and Yash Mehta

Abstract: Introduction: Ewing’s sarcoma develops in second decade of life with median age of 13 years. It is second most common primary pediatric bone malignancy and more common in males. Ewing’s sarcoma has “triad’’ of findings(1) “diaphyseal’’ location,(2) “round-cell’’ or “permeative’’ lytic destruction of bone with periosteal elevation in lamellated fashion(3) large soft-tissue mass associated with tumor. The case is of 19 year male having Left proximal femur Ewings sarcoma who presented to NCH, Surat with C/O pain in left hip since 9 months after trivial trauma. After 2 months, Patient had undergone FNAC which misdiagnosed it as Giant cell Tumour and treated with Curettage + Bone graft. Then patient was correctly diagnosed as Non-Metastatic Ewing’s Sarcoma after MRI and PET scan. MRI is the best imaging study to assess the extent of medullary osseous involvement and soft-tissue extension. PET showed FDG avid lytic lesions in GT and proximal shaft femur.Methods and Materials: Treatment of Ewing’s sarcoma consists of neoadjuvant preoperative chemotherapy, followed by limbsparing surgery and consolidation chemotherapy. Modern neo-adjuvant chemotherapy regimen include Ifosfamide, Etoposide with vincristine, dactinomycin, cyclophosphamide, doxorubicin (VACA). After 6 cycles of preoperative chemotherapy, we chose surgically resecting the tumor with wide margin followed by Megaprosthesis consisting of proximal femoral component, tumor resection stem, femoral head, and cement. Results: Patient had started complete weight bearing after 2 weeks postop and taken 1 cycle of chemotherapy postop. But patient developed infection and exposed implant stem. Hence VAC dressing was applied for 6 weeks and then patient was finally operated with Rotational flap surgery after infection was cleared. Conclusion: Megaprosthesis Replacement is an excellent Limb salvaging surgery giving complete range of motion and functional outcome in Proximal Femur Ewing’s sarcoma not involving vital structures.

DOI: 10.22271/27078345.2024.v6.i1b.198

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