Extraskeletal Ewing's sarcoma: An adrenal localization

Introduction: Ewing's sarcoma is a frequent bone malignant tumor in children and young adults. Its extraskeletal primitive localization is less common which makes its diagnosis less obvious. Case Report: We report a case of a 16-year-old female who presented at our department for one month history of pleuritic chest pain. The physical examination and the thoracic radiography results supported a pleural effusion. The results of the first thoracentesis and pleural biopsy were not conclusive, thus a second thoracentesis was attempted but did not withdraw any pleural fluid. A thoracoabdominal computed tomography (CT) scan was performed which found a large infraphrenic tumor suspecting an adrenal neuroblastoma. A CT guided biopsy was done and the histopathology study revealed a malignant proliferation made of medium sized round cells. The immunohistochemistry concluded to Ewing's sarcoma. The diagnosis of primitive adrenal gland neuroectodermal tumor was established and adjuvant chemotherapy was recommended. The patient passed away during her first chemotherapy session. Conclusion: The adrenal localization of Ewing's sarcoma is rare. A neuroblastoma is the first brought up diagnosis in such presentation but an extraskeletal neuroectodermal tumor is also possible.