Abstract
Extra-skeletal Ewing’s sarcoma (ESS) is rarely found in the head and neck region, soft tissue presentation of Ewing’s sarcoma is uncommon, morphologically it resembles Ewing’s sarcoma originates from bone. We report a case of extra-skeletal Ewing’s sarcoma of the submandibular gland region in a 34-year-old male including clinical, radiological, histopathological presentation and, treatment plan. To the best of our knowledge, it has been once only reported to arise from the submandibular gland.
Highlights
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Extra-skeletal Ewing’s sarcoma (ESS) is rarely found in the head and neck region and soft tissue presentation of Ewing’s sarcoma is uncommon.
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Morphologically it resembles Ewing’s sarcoma originates from bone.
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Here we report a case in a 34-year-old male including clinical, radiological, histopathological presentation and, treatment plan.
Credit author
Abdul-Aziz Alaqeeli: Writing original draft, investigations and editing. Mohamed Amir: writing, reviewing and editing. Belal Alani: writing, reviewing and editing. Moustafa Alkhalil: Supervising.
1
Case presentation
A 35-year-old male, presented to the department of Oral and Cranio-Maxillofacial surgery at Hamad medical corporation, Doha/Qatar, with a chief complaint of a progressively enlarging mass in the right side of upper neck region for 3 weeks duration accompanied by oral pain and difficulty to swallow, he is otherwise healthy with no past medical or surgical history.
Upon clinical examination, he had a well localized fixed 4*4 cm mass in the right-side submandibular region and upper cervical area Figs. 1 and 2 the overlying skin was intact, the mass was firm, tender on palpation. No restriction of neck mobility, trachea in the midline and was unremarkable for cervical lymphadenopathy.
Intraoral examination revealed a right ulcerous-proliferative lesion in the floor of mouth of 3*1 cm in size, endophytic with irregular margins and occupying most of the sublingual region, on palpation it was tender and clearly connected to the external submandibular mass on bimanual palpation. Figs. 3 and 4 .
At his first presentation to the emergency department, an ultrasound of the neck that reported as a solid echogenic avascular lesion in the right submandibular region in close relation to the right submandibular gland medial aspect. According to the clinical nature and course of the mass, urgent MRI requested, Figs. 5–8 & 8 , showed evidence of right sublingual space/floor of the mouth, well defined ovoid mass lesion, measuring about 43 × 21 × 35 mm in AP x TV x CC dimensions, respectively, and a right submandibular space similar appearing ovoid mass lesion 30 × 46 × 52 mm in AP x TV x CC dimensions respectively, with similar characteristics, and a central non enhancing area separated from the first lesion by the mylohyoid muscle.
