Curatively Resected Mesenteric Lymph Node Recurrence of Ewing Sarcoma.

Abstract

Introduction: We report herein a rare case of Ewing sarcoma that metastasized to the mesenteric lymph nodes.

Case presentation: The patient was a 40-year-old female with Ewing sarcoma of the 1st lumbar vertebra, which was treated with chemotherapy and stereotactic radiotherapy. No local recurrence or distant metastasis was observed during the first 3-year follow-up period after treatment. Three years later, she presented to the emergency department with muscle weakness. A 60-mm lesion in the right parieto-occipital lobe of the brain and a 40-mm tumor in the small bowel mesentery were detected. Emergency craniotomy confirmed a cerebral metastasis of the Ewing sarcoma. The patient subsequently underwent 6 cycles of ifosfamide (IFM) monotherapy, which reduced the mesenteric tumor to 10 mm in size. Surgical resection was performed with clear margins. Histopathological examination of the mesenteric lymph nodes confirmed the findings of the emergency craniotomy. The patient continues to receive IFM monotherapy as adjuvant chemotherapy. Although brain metastases developed at postoperative months 1, 6, and 10, no intra-abdominal recurrence was observed during the 1-year surveillance period.

Conclusions: While Ewing sarcoma can metastasize to isolated distant lymph nodes, oligometastases can be treated with surgical resection.