A 6-year-old from Uzbekistan gets a new lease of life from recurrent Ewing Sarcoma

–Vinod Kumar

New Delhi: A city Hospital has successfully treated a six-year-old patient from Uzbekistan suffering from recurrent round cell tumor, identified as PNET/Ewing sarcoma. 

Thanks to the unwavering efforts by multiple teams Of Aakash Healthcare Super Specialty Hospital, Dwarka, the child doesn’t have any evidence of residual tumor in her body. The case highlights the importance of prompt and comprehensive interventions in pediatric oncology, demonstrating positive outcomes even in aggressive tumor scenarios.

The multidisciplinary approach, including neoadjuvant chemotherapy, wide local excision, and reconstructive surgery played a crucial role in achieving a tumour cure.

The six-year-old child’s journey unfolded in Uzbekistan in December 2022, where she presented with complaints of a neck lump in the occipital region. The child subsequently underwent surgery to remove the lump. Unfortunately, fate had it otherwise as the neck mass returned in the months following surgery and again, she had to undergo the knife for excision of the lump. Post second surgery, the patient’s family moved to India to seek further management as she experienced tumor recurrence with rapid tumor growth this time around.

“The little one presented at Aakash Healthcare Super Specialty Hospital, Dwarka with a huge mass in her neck. The medical team at Aakash immediately sprang into action - a contrast enhanced MR imaging (ceMR) of the neck revealed a large, well-defined lobulated mass lesion (9.4 x 7.1 x 12 cm) in the right posterior neck space. A biopsy indicated a round cell tumor with a Ki-67 index of 90% and was suggestive of PNET/Ewing sarcoma, Dr. Parveen Jain, Senior Consultant & Head of Department, Oncology, Aakash Healthcare Super Specialty Hospital, Dwarka, said,

The case was discussed in a Multidisciplinary Tumor Board (MSC), leading to the decision to proceed neoadjuvant chemotherapy (NACT) followed by local therapy.

Shedding light on the further management of the case, Dr. Arun Kumar Giri, Director, Department of Surgical Oncology at Aakash Healthcare Super Specialty Hospital, Dwarka, said, “The patient underwent three chemotherapy sessions that led to significant tumor shrinkage followed by surgery. The surgical procedure was divided into two parts – resection through a wide local excision and rotational flap reconstruction with skin grafting of the donor area to address the residual mass. Histopathological examination (HPE) confirmed patchy residual round cell tumor consistent with the initial biopsy's diagnosis of PNET/Ewing sarcoma.”

Dr. Aashish Chaudhry, Managing Director, Aakash Healthcare Super Specialty Hospital, Dwarka, remarked, "This case exemplifies the power of a multidisciplinary and collaborative approach in addressing complex medical conditions. The successful outcome underscores the importance of teamwork and expertise across specialties. This case reaffirms our commitment to pushing boundaries for the well-being of our patients and reflects the spirit of 'We try, we shall succeed' at Aakash Healthcare.”

This case illustrates the successful management of recurrent PNET/Ewing sarcoma in a pediatric patient through a comprehensive treatment approach. The integration of neoadjuvant chemotherapy, wide local excision and reconstructive surgery resulted in significant tumor cure and positive outcomes. The patient is currently undergoing adjuvant chemotherapy and is planned for radiotherapy in the coming months. The case emphasizes the importance of tailored interventions in pediatric oncology, showcasing the potential for favorable responses even in challenging scenarios.