(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect the privacy of the child)
Abstract: The patient in this case is a 7-year-old boy. At the time of discovery, the child had no abnormalities other than occasional vague pain in the shoulder joint. By chance, the parents noticed swelling in the shoulder when bathing the child, and after visiting our clinic, the initial diagnosis was a bone malignancy. Combining the child’s age, the location of the lesion, and imaging examinations, the final diagnosis was Ewing sarcoma, a kind of bone malignant tumor. After surgery + chemotherapy, the tumor showed no signs of recurrence or metastasis, and the child recovered well from the function and had a good shoulder profile.
[Basic information] Male, 7 years old
Disease Type】Ewing sarcoma
Hospital】Bone Oncology Department, Peking University People’s Hospital
Consultation date】May 2019
Treatment plan】Surgical treatment (scaphoid tumor resection and reconstruction surgery, posterior pelvic plication, deltoid reconstruction) + chemotherapy (etoposide injection, isocyclophosphamide for injection)
[Treatment period] 8 months
Treatment effect】No recurrence, no metastasis, good recovery of shoulder joint shape and function in the postoperative follow-up
I. Initial consultation
The child’s parents were referred to me by others. When we first met, the child had been delayed in the local hospital for some time, and the lesions around the shoulder joint were already very obvious. Nuclear magnetic examination revealed: a huge soft tissue tumor of the scapula. Bone malignant tumors in children and adolescents need to be diagnosed and treated early, so the child was given an early hospitalization and underwent a CT scan of the chest, an MRI, and a PET-CT of the whole body. The MRI revealed a very extensive tumor that formed a huge mass. The pathological results confirmed Ewing sarcoma, and no other lesions were found in the examination results.
II. Treatment history
After the diagnosis was clear, we had a thorough communication with the child’s family. Because Ewing sarcoma is a rare disease, the child’s parents did not know about the treatment process, the treatment method and the prognosis. After a thorough communication, the currently common international chemotherapy regimen was selected, which included etoposide injection and isocyclophosphamide for injection. After the preoperative chemotherapy, the child’s symptoms were significantly relieved and the mass was significantly reduced, which indicated that the treatment was effective. By the time the preoperative chemotherapy was completed, the tumor mass had completely retracted on the MRI. At the time of surgery, according to the extent of lesion involvement and the child’s age, scaphoid tumor resection and reconstruction surgery, posterior glenoplasty, and deltoid reconstruction were performed, and postoperative chemotherapy was continued after the surgery.
III. Treatment results
The child recovered quickly after the surgery. About one month after the surgery, the shoulder joint was able to perform forward flexion, back extension and abduction functions, while the activities of the elbow, wrist and hand were not affected at all. By the time the post-operative chemotherapy was over, the child’s shoulder joint was pain-free and basically moving freely, with the exception of slightly limited abduction function, which was basically normal. At the review 1 year after surgery, the parents described that the child could ride a bicycle, jump rope, single bar, double bar and other activities, and the functional recovery was very satisfactory. There was no difference in the shape of the shoulder joint compared with the contralateral side. In conclusion, there was no recurrence and no metastasis in the postoperative follow-up, and the shape and function of the shoulder joint recovered well.
IV. Notes
We are glad that the child’s symptoms have improved after the treatment, but because of the importance of postoperative follow-up of bone malignant tumor, the local and general conditions of the lesion should be checked regularly within 3 years after the operation, and the follow-up should be conducted once every 3 months within 2-3 years after the treatment, and gradually extend the time afterwards. The examination includes physical examination, local X-ray, CT, MRI, etc. If necessary, consider a bone scan examination or PET-CT for a comprehensive examination. In addition, regular functional exercises, such as strength training of biceps and deltoid muscles, are required for the recovery of postoperative shoulder function. The necessary training can effectively improve the postoperative function and promote the functional recovery of the shoulder joint.
V. Personal insight
Bone malignant tumors are often insidious and sometimes difficult to detect when the lesions are relatively small. In clinical work, there are often cases that bone tumors are found only when the lesions are large. Because the larger the size of tumor, the faster it grows, so it is very important to find out bone malignant tumor in time for diagnosis and timely treatment to avoid delay.
As in this case, it is a 7-year-old child, and because of its high functional plasticity, the choice of surgical approach needs to take into account the recovery of postoperative function, the need for long-term effective and stable reconstruction techniques, and efforts to reduce long-term complications on the basis of complete tumor removal. Considering the future development of the child’s bones and muscles, the starting point of the articular pelvis and deltoid muscle were repaired, and the fulcrum and power system of the shoulder joint movement were reconstructed, and these repairs played a crucial role in the postoperative shoulder joint movement. The child’s good functional recovery of the shoulder joint after surgery confirms the effectiveness of this approach, which is now seen to be well suited for this type of surgical child.
It is very important for the surgeon to communicate with the child and family in a timely manner before and after surgery. The treatment of bone malignant tumors is a relatively long process, and there may be many situations during chemotherapy, before and after surgery that require timely doctor-patient communication to achieve the best treatment results.