Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Joseph Junewick, MD FACR
over 10 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Ewing Sarcoma - Clavicle

Case Detail

Anatomy: Musculoskeletal
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: CT NM
Adobe32 PDF Imagej32 ImageJA


17 year old male with slowly enlarging firm clavicular mass.

Case Images


Ewing Sarcoma

Clinical Notes

No history of trauma.

Pathology – Sheets of small round blue cells with minimal cytoplasm; positive membranous CD99 and nuclear FLI-1 and negative EMA, HHF-35, and LCA.


CT – Axial and coronal reformat show permeative osteolysis of the right clavicle with sunburst periosteal new bone and minimal extraosseous soft tissue mass.

PET – Marked focal hypermetabolic right clavicular lesion with no evidence of metastatic disease. Note the physiologic activity in the forearm musculature.


PET-CT may be helpful in both initial assessment and for re-staging of Ewing sarcoma. PET-CT will more accurately determine the extent of disease at initial staging. PET-CT also offers metabolic response in addition to anatomic response to preoperative chemotherapy on restaging examinations. FDG-PET in detecting osseous metastatic disease from Ewing sarcoma are superior to those of bone scintigraphy. Uncovering additional metastatic disease will allow targeted radiotherapy and ultimately influence patient outcome. It is not uncommon to have anatomic distortions at the primary site related to treatment which are also mildly photodense on scintigraphy. PET-CT will likely play a role in the differentiation of post-treatment changes from recurrent Ewing sarcoma.


Hawkins DS, et al. Evaluation of chemotherapy Response in Pediatric Bone Sarcomas by [F-18]-fluorodeoxy-D-glucose Positron Emission Tomography. Cancer 2002; 94:3277-84.

Aoki J, Wantanabe H, Shinozaki T, et al. FDG PET of Primary Benign and Malignant Bone Tumors: Standardized Uptake Values in 52 lesions. Radiol 2001; 219:774-777.

Dyke JP et al. Osteogenic and Ewing Sarcomas: Estimation of Necrotic Fraction During Induction Chemotherapy with Dynamic Contrast-enhanced MR Imaging. Radiol 2003; 228(1):271-8

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare