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June 3, 2026Clinical Medicine Insights Case Reports0 citationsOpen Access

No Identifiable Primary, Only Metastases: Case Report of a Small Round Blue Cell Tumor Consistent With Ewing Sarcoma Presenting With Multisystem Spread in a Young Woman

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SISimra IrfanAMAhmed MuneebMUMallick Muhammad Zohaib Uddin

Key Result

Multi-agent chemotherapy and supportive care were used to manage a 31-year-old woman with widespread metastatic Ewing sarcoma without an identifiable primary lesion.

Key Points

  • This case report aims to illustrate the rare presentation of Ewing sarcoma with no identifiable primary tumor.
  • Presented a case of a 31-year-old woman
  • Utilized extensive imaging to search for a primary lesion
  • Managed with multi-agent chemotherapy and supportive care
  • Widespread metastatic disease was found in lung, spine, and brain areas.
  • Patient experienced neuropathic pain, seizures, and treatment-related infections.
  • Ultimately, she left treatment against medical advice due to socioeconomic constraints.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 31-year-old woman with widespread metastatic disease suggestive of Ewing sarcoma, including lung, spinal, and brain involvement.
I
Intervention
Multi-agent chemotherapy and supportive care

This case highlights the diagnostic and therapeutic challenges of managing widespread metastatic Ewing sarcoma with an unidentifiable primary lesion in a low-resource setting.

Abstract

Ewing sarcoma is the second most common malignant bone tumor in children and adolescents but remains rare and highly aggressive. We present the case of a 31-year-old woman with widespread metastatic disease suggestive of Ewing sarcoma, including lung, spinal, and brain involvement at presentation; however, no dominant primary lesion was identified despite extensive imaging. The patient’s clinical course was complicated by neuropathic pain, seizures, and severe treatment-related infections. She was managed with multi-agent chemotherapy and supportive care but ultimately left against medical advice due to socioeconomic constraints. This case illustrates the diagnostic and therapeutic challenges of Ewing sarcoma in low-resource settings and underscores the importance of early detection, molecular confirmation, and multidisciplinary management.

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Cite This Study

Irfan et al. (2026) conducted a case report in Ewing sarcoma (n=1). Multi-agent chemotherapy and supportive care was evaluated. Multi-agent chemotherapy and supportive care were used to manage a 31-year-old woman with widespread metastatic Ewing sarcoma without an identifiable primary lesion.

synapsesocial.com/papers/6a1fc696dee9eb8c0dce784bhttps://doi.org/10.1177/11795476261457179
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