Fig. 11.

A 1-year-old boy suddenly suffered a pain in his right lower leg without any obvious cause. a A plain X-ray showed a radiolucent lesion and widening of the diaphysis of his right tibia. A periosteal reaction was also observed. b T2-weighted imaging demonstrated an area of high signal intensity in the tibia. An open biopsy resulted in a diagnosis of ES of the tibia. After preoperative chemotherapy composed of 6 courses of VIDE according to the protocol outlined in the Euro-EWING 99 study, radiotherapy involving 55.8 Gy was performed as a local therapy. After the radiotherapy, one course of the VAI regimen and 7 courses of the VAC regimen were administered. When the patient was 9.5 years old, CT detected lymph node swelling in his neck. A biopsy of the lymph node demonstrated metastasis from papillary thyroid cancer. The patient underwent excision of his right thyroid lobe and the swollen lymph node. c He displayed a 5-cm leg length discrepancy at 10 years after the local therapy