Roentgen manifestations in Ewing's sarcoma.A study of 156 cases

A study of the roentgenographic manifestations in 156 cases of histologically diagnosed Ewing's sarcoma of bone is presented. Ewing's sarcoma formed 30% of primary malignant bone tumors seen at our hospital. Flat bones were as frequently involved (69 cases) as long tubular bones (77 cases). The disease was located considerably more often at or near the ends of long bones (60 cases) than in midshaft (17 cases). Roentgenograms showed a wide variety of changes. Destructive changes varied from fine stippled osteolysis, superficial erosion to extensive destruction associated with a large soft tissue mass and either no periosteal reaction or periosteal reaction of “onion peel,” “sun-ray” or “combined type.” Occasionally scattered sclerosis may be seen. Many of these roentgenographic changes, however, may be present in other types of lesions. Roentgenographic diagnosis of Ewing's sarcoma is, therefore, at best a presumptive diagnosis and requires histological confirmation in all cases.