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Abstract
Background Skip lesions in Ewing's sarcoma of the bone seem to be rare; to our knowledge only 7 cases have been published in the English medical literature.
Methods We retrospectively reviewed imaging and histological data relating to 235 patients with non-metastatic Ewing's sarcoma of the bone who participated in the cooperative Ewing's sarcoma study (CESS 86 and CESS 91), and we identified 15 patients with a skip lesion at diagnosis.
Results The skip lesion was located in the same bone as the primary tumor in 13 patients, and in an adjacent juxtaarticular bone in 2 cases. The average follow-up was 11 years. Despite aggressive treatment including surgery in all cases, tumor relapse occurred in 9 patients, and 7 of these patients died due to metastatic disease.
Interpretation Skip lesions in patients with otherwise non-metastatic skeletal Ewing's sarcoma may be of the same consequence as the molecular detection of marrow metastases and possibly confer a worse prognosis. Newer imaging modalities (for example PET) and careful staging work-up may indicate that skip metastases in Ewing's sarcoma are more common than previously suspected.
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