1. Case Presentation M. S. 13 y.o., male Toril, Davao City
cc: anterior chest wall mass

2. HPI: 9 mos hx of L anterior chest pain
5 mos persistent pain; palpable mass L ant. chest (~2cms)
1 mo rapid increase in size of mass which later ulcerated associated with purulent foul smelling discharge; DMC Surgery OPD; excision biopsy was done; result reported as Ewing’s sarcoma
Few hours prior to admission, bleeding from mass; admitted at Surgical ward

4. Physical examination Vital signs BP=90/60 RR=21 BEE=1200 kcal/day
T=35.5 CR=122 BMI=13.8 kg/m2
Conscious; coherent; NICRD; afebrile
Anicteric sclerae; pale palpebral conjunctivae; (-) lympadenopathies
Asymmetrical chest expansion; clear breath sounds
(+) 10 x 10 cm nodular, ulcerating mass with purulent foul smelling left anterolateral chest
Adynamic precordium; NRRR; (-) murmurs
Flat, soft abdomen; (-) tenderness; (-) palpable masses
Full equal pulses; pale nail beds

5. Initial Laboratory Investigations
CBC
WBC 7.73
Hb 160
Hct 0.50
Rbc 5.67
Diff count
Neut 80%
Lym 13%
Mono 7%
Protime
PT pt 12.4
PT INR 1.03PT % activity 92%
PT control 13.3

6. CXR result: Anterior chest wall mass, left, with pleural, pulmonary, osseous, axillary lymph nodes metastasis.

7. Surgical Pathology Report
Specimen
6th rib mass
Gross description
specimen consists of 2.0 cm aggregate of creamy white to brown tissue fragments
Microscopic description
sections show sheets of small atypical cells showing large hyperchromatic nuclei and very scant cytoplasm. These cells are thrown into poorly formed lobules in some areas by very thin fibrous stroma. Large areas of necrosis are seen among the atypical cells
Diagnosis:
consistent with Ewing’s sarcoma

8. Impression: Ewing’s sarcoma stage IV ( T2b, N1,M1 ) anterolateral chest