Case Report: Localized Ewing’s sarcoma of the scapula in an adult

Background: Ewing’s sarcoma (ES) of the scapula is a rare entity. It is often discovered late at the metastatic stage of the disease because of its deep location. This neoplasm is common in children and adolescents. We present the first reported case of a localized Ewing’s sarcoma of the scapula in an adult over 40 years-old. Case presentation: A 48-year-old man presented with left shoulder pain evolving for one year. Physical examination showed a painful, ill-defined swelling of the left shoulder measuring 5 x 3 cm. Magnetic resonance imaging (MRI) was performed showing a mass of the left scapula invading the soft tissues of the shoulder suggestive of a sarcoma. The patient underwent a surgical biopsy finding an ES of the scapula with no secondary localization on the computerized tomography (CT) scan nor on the bone scintigraphy. Neo-adjuvant multiagent chemotherapy was started obtaining a total response. Therefore, the patient underwent a total left scapulectomy. Histopathological examination confirmed the diagnosis of ES with a complete response to chemotherapy. Adjuvant chemotherapy was then indicated. After 3 years of follow-up, no local or distant recurrence was found. Discussion: ES is a high-grade aggressive lesion that most commonly originates in bone. The ES may affect any bone but is frequent in femur, tibia and ilium, the tumors arising from the scapula comprise fewer than 4% of all ES. No cases of localized Ewing’s sarcoma in adults have been reported to our knowledge. The diagnosis is confirmed by immunohistochemical examination and cytogenic. A multimodal treatment approach including a combination of chemotherapy, surgery, and radiation can modestly improve local tumor outcomes. Metastatic tumors still have poor diagnosis. Conclusions: ES occurs rarely in adults greater than 20 years-old, and tumors localized in the scapula are even rarer. Histopathology differentiates it from other primary bone/soft tissues tumors.