A Case of Ewing Sarcoma of the Mandible on 18F-FDG PET/CT

Document Type: Case report


1 Department of Radiology, Faculty of Medicine, Kagawa University, Japan

2 Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Japan


Ewing Sarcoma is the second most common type of bone cancer in children. The dominant features of this malignant bone tumor are the tendency for rapid growth and metastasis.  In addition, Ewing sarcoma of the mandible is extremely rare and can be mistaken for odontogenic infection. We report a 14-year-old girl who had had swelling, pain, and hypoesthesia in the left cheek for three weeks.  She was diagnosed with pericoronitis initially, and then referred toour hospital due to worsening symptoms.  CT and MRI revealed an expanding and destructive mass mainly in the left mandible.  18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and fused PET/CT demonstratedincreased uptake in the mandibular lesion.  Whole-body 18F-FDG PET images showed no abnormal activity except for the mandibular lesion.  Histologic examination confirmed Ewing sarcoma.  Although this tumor has an aggressive clinical behavior and rapid growth, early diagnosis can reduce patient’s morbidity, mortality and thus it is important to distinguish it from periodontal inflammation.


Main Subjects

1. Esiashvili N, Goodman M, Marcus RB Jr. Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance Epidemiology and End Results data. J Pediatr Hematol Oncol. 2008; 30(6):425-30.

2. Gorospe L, Fernández-Gil MA, García-Raya P, Royo A, López-Barea F, García-Miguel P. Ewing's sarcoma of the mandible: radiologic features with emphasis on magnetic resonance appearance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91(6):728-34.

3. Gosau M, Baumhoer D, Ihrler S, Kleinheinz J, Driemel O. Ewing sarcoma of the mandible mimicking an odontogenic abscess - a case report. Head Face Med. 2008; 4:24.

4. Brazão-Silva MT, Fernandes AV, Faria PR, Cardoso SV, Loyola AM. Ewing's sarcoma of the mandible in a young child. Braz Dent J. 2010; 21(1):74-9.

5. Keshani F, Jahanshahi G, Attar BM, Kalantari M, Razavi SM, Hashemzade Z, et al. Ewing's sarcoma in mandibular similar to dental abscess. Adv Biomed Res. 2014; 3:62.

6. Balkaya E, Bozkurt C, Aksu AE, Özmen S, Özdemir Sİ, Şahin G. Ewing`s sarcoma of the mandible misdiagnosed as periodontal inflammation: Report of three cases. Turk J Pediatr. 2017; 59(6):704-7.

7. Behnia H, Motamedi MH, Bruksch KE. Radiolucent lesion of the mandibular angle and ramus. J Oral Maxillofac Surg. 1998; 56(9):1086-90.

8. Treglia G, Salsano M, Stefanelli A, Mattoli MV, Giordano A, Bonomo L. Diagnostic accuracy of ¹8F-FDG-PET and PET/CT in patients with Ewing sarcoma family tumours: a systematic review and a meta-analysis. Skeletal Radiol. 2012; 41(3):249-56.

9. Sharma P, Khangembam BC, Suman KC, Singh H, Rastogi S, Khan SA, et al. Diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Eur J Nucl Med Mol Imaging. 2013; 40(7):1036-43.

10. Margaix-Muñoz M, Bagán J, Poveda-Roda R. Ewing sarcoma of the oral cavity. A review. J Clin Exp Dent. 2017; 9(2):e294-e301.

11. Vohra VG. Roentgen manifestations in Ewing's sarcoma. A study of 156 cases. Cancer. 1967; 20(5):727-33.

12. Lopes SL, Almeida SM, Costa AL, Zanardi VA, Cendes F. Imaging findings of Ewing's sarcoma in the mandible. J Oral Sci. 2007; 49(2):167-71.

13. Gupta K, Pawaskar A, Basu S, Rajan MG, Asopa RV, Arora B, et al. Potential role of FDG PET imaging in predicting metastatic potential and assessment of therapeutic response to neoadjuvant chemotherapy in Ewing sarcoma family of tumors. Clin Nucl Med. 2011; 36(11):973-7.

14. Harrison DJ, Parisi MT, Shulkin BL. The role of ¹8F-FDG PET/CT in pediatric sarcoma. Semin Nucl Med. 2017; 47(3):229-41.

15. Quartuccio N, Fox J, Kuk D, Wexler LH, Baldari S, Cistaro A, et al. Pediatric bone sarcoma: diagnostic performance of ¹8F-FDG PET/CT versus conventional imaging for initial staging and follow-up.  AJR. 2015; 204(1):153-60.

16. Yogesh TL1, Shetty A2, Keswani H1, Rishi D. Aggressive high-grade Ewing’s sarcoma of maxilla: A rare case report.  J Oral Maxillofac Pathol. 2018; 22:S48-S53.