ewing sarcoma

A nine-year-old child is hospitalised in October 1999 and diagnosed with Ewing’s Sarcoma on the right humerus.
Several chemotherapy cycles are performed until he undergoes surgery on February 2, 2000, during which the neo-formation in the humeral bone is removed and a peroneal bone segment is grafted and stabilised with two splints and nine screws.

The histological diagnosis of February 21 2000 confirms that it is the Ewing/PNET Sarcoma.
More chemotherapy cycles are performed in 2000.

An ecographic scan of the right arm performed on October 9, 2000, however, states as follows:

“…sharp irregularity of the humerus’s bone profile…”.

On January 29, 2001 he is hospitalised with a diagnosis of relapsed Ewing’s Sarcoma of the right humerus and with:“…clear re-absorption of the splint…”. Later, on February 12, 2001, a second surgical operation is performed with new peroneal graft and stabilisation with splints and screws. During the operation, a new relapse in the auxillary cavity is noticed and removed.

An echographic scan of May 7, 2001 (figure 1), however, shows another three instances of Ewing’s Sarcoma to the right arm with the following dimensions:

First: 60 x 30 x 40 mm
Second: 24 x 18 x 20 mm
Third: 44 x 31 x 32 mm

In June 2001 the child’s father decides to proceed with the sodium bicarbonate salts treatment, which is administered by catheter into the right sub-clavian artery in order to administer the salts (phleboclysis of 500 cc at five per cent) directly on the tumoral masses.

CAT of July 2, 2001
“Post-surgical results of the positioning of metal osteosynthesis means in location of humerus without evidence of local tissue tumefaction”
* Echo-scan of July 9, 2001
“The results show an almost complete regression of the expanding formation of the upper third and of the medial face of the arm; however, the expanding formation of the third lower medial (anterior lateral face) persists.”
* PET of July 11, 2001
“An area of hyperactivity is noticed on the anterior lateral surface of the third lower medium of the right arm, probably at the side of the bone”.
* Echo-scan of September 10, 2001
“The ecographic results show a complete regression of the expanding formation of the third superior and of the medium area of the arm; the expanding formation of the third  medium  (anterior lateral face) persists. However, the formation exhibits a sharp volumetric reduction of about 50 per cent when compared to the scan of July 9, 2001”

Conclusions: of the 3 masses shown by the echo of May 7, 2001, whose size is respectively
a. 6,5 cm
b. 4,4 cm
c. 2,4 cm

After the sodium bicarbonate salts treatment only one is left, with a size of 1.5 cm, which is most likely residual scarring, as shown by the echography of September 10, 2001.


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