A unique pediatric thoracic tumor: A case report of mediastinal Ewing sarcoma

Ewing's sarcoma is a rare tumor occurring in the mediastinum. It is a malignant, aggressive, and rapidly growing tumor that often lacks distinctive clinical or radiological features. Diagnosis is primarily made through histological and immunocytochemical examination. Complete surgical excision followed by chemotherapy is the preferred treatment. We present a case of a child who initially presented with mild respiratory distress. The condition rapidly progressed, leading to an external misdiagnosis and the placement of a chest defibrillator due to misinterpreted findings. The child was referred to our institution, where a large mediastinal mass was diagnosed and surgical intervention was undertaken to completely resect the mass and confirm the diagnosis of Ewing's sarcoma. It is crucial for medical practitioners, especially surgeons, to include Ewing's sarcoma in the differential diagnosis of mediastinal lesions. This consideration is essential for developing an appropriate surgical intervention plan and subsequent follow-up. Our case highlights several important points in clinical practice. It emphasizes the need to avoid relying solely on non-contrast CT scans when a mass is suspected. Additionally, fine-needle aspiration (FNA) should be considered for mass lesions to establish a diagnosis before surgical intervention, as some conditions, such as lymphoma, may not require surgery. Our case also demonstrates the successful removal of a large chest mass through a posterior lateral thoracic approach. •Ewing's sarcoma is a very rare tumor of the mediastinum, especially in children.•These tumors are rapidly growing and highly aggressive with nonspecific clinical presentations.•Histological and immunocytochemical examination is crucial for the primary diagnosis.•Surgical resection followed by chemotherapy is considered the gold standard treatment due to the high recurrence rate of these tumors.