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Ewing sarcoma

Classication and external resources

Micrograph of metastatic Ewing sarcoma (right o

image) in normal lung (left of image). PAS stain

ICD-9 170.9 (http://www.icd9data.com/

getICD9Code.ashx?icd9=170.9)

ICD-O: M9260/3

(http://www.progenetix.net/

progenetix/I92603/)

OMIM 133450 (http://omim.org/entry/

133450)

DiseasesDB 4604

(http://www.diseasesdatabase.comddb4604.htm)

MedlinePlus 001302 (http://www.nlm.nih.gov/

medlineplus/ency/article/

001302.htm)

eMedicine ped/2589

(http://www.emedicine.com/ped/

topic2589.htm)

MeSH D012512 (http://www.nlm.nih.gov

cgi/mesh/2011/MB_cgi?eld=uid&term=D012512

Ewing's sarcomaFrom Wikipedia, the free encyclopedia

Ewing sarcoma is a malignant round-celltumour. It is a rare disease in which cancer

cells are found in the bone or in soft tissue.The most common areas in which it occursare the pelvis, the femur, the humerus, theribs and clavicle.

Because a common genetic locus isresponsible for a large percentage of Ewingsarcoma and primitive neuroectodermaltumors, these are sometimes groupedtogether in a category known as the Ewing

family of tumors.

[1]

The diseases are,however, considered to be dierent:peripheral primitive neuroectodermal tumoursare generally not associated with bones, whileEwing sarcomas are most commonly relatedto bone.

Ewing sarcoma occurs most frequently inmale teenagers, with a male/female ratio of

1.6:1.[2]

Although usually classied as a bone tumour,Ewing sarcoma can have characteristics ofboth mesodermal and ectodermal origin,

making it dicult to classify.[3]

Contents

1 Eponym

2 Causes

3 Clinical ndings

4 Imaging ndings

5 Clinical dierential diagnosis

6 Diagnosis

7 Epidemiology

http://en.wikipedia.org/wiki/Ewing%27s_sarcoma
http://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/PAS_stainhttp://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=170.9http://www.icd9data.com/getICD9Code.ashx?icd9=170.9http://en.wikipedia.org/wiki/International_Classification_of_Diseases_for_Oncologyhttp://en.wikipedia.org/wiki/ICD-Ohttp://www.progenetix.net/progenetix/I92603/http://www.progenetix.net/progenetix/I92603/http://www.progenetix.net/progenetix/I92603/http://en.wikipedia.org/wiki/OMIMhttp://omim.org/entry/133450http://omim.org/entry/133450http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb4604.htmhttp://www.diseasesdatabase.com/ddb4604.htmhttp://www.diseasesdatabase.com/ddb4604.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/001302.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001302.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001302.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/ped/topic2589.htmhttp://www.emedicine.com/ped/topic2589.htmhttp://www.emedicine.com/ped/topic2589.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D012512http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D012512http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D012512http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Pelvishttp://en.wikipedia.org/wiki/Femurhttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Ribshttp://en.wikipedia.org/wiki/Primitive_neuroectodermal_tumorhttp://en.wikipedia.org/wiki/Primitive_neuroectodermal_tumorhttp://en.wikipedia.org/wiki/Ewing_family_of_tumorshttp://en.wikipedia.org/wiki/Ewing_family_of_tumorshttp://en.wikipedia.org/wiki/Teenagershttp://en.wikipedia.org/wiki/Mesodermhttp://en.wikipedia.org/wiki/Ectodermhttp://en.wikipedia.org/wiki/Ectodermhttp://en.wikipedia.org/wiki/Mesodermhttp://en.wikipedia.org/wiki/Teenagershttp://en.wikipedia.org/wiki/Ewing_family_of_tumorshttp://en.wikipedia.org/wiki/Ewing_family_of_tumorshttp://en.wikipedia.org/wiki/Primitive_neuroectodermal_tumorhttp://en.wikipedia.org/wiki/Primitive_neuroectodermal_tumorhttp://en.wikipedia.org/wiki/Ribshttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Femurhttp://en.wikipedia.org/wiki/Pelvishttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Cancerhttp://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D012512http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D012512http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D012512http://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.emedicine.com/ped/topic2589.htmhttp://www.emedicine.com/ped/topic2589.htmhttp://www.emedicine.com/ped/topic2589.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.nlm.nih.gov/medlineplus/ency/article/001302.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001302.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001302.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.diseasesdatabase.com/ddb4604.htmhttp://www.diseasesdatabase.com/ddb4604.htmhttp://www.diseasesdatabase.com/ddb4604.htmhttp://en.wikipedia.org/wiki/Diseases_Databasehttp://omim.org/entry/133450http://omim.org/entry/133450http://en.wikipedia.org/wiki/OMIMhttp://www.progenetix.net/progenetix/I92603/http://www.progenetix.net/progenetix/I92603/http://www.progenetix.net/progenetix/I92603/http://en.wikipedia.org/wiki/ICD-Ohttp://en.wikipedia.org/wiki/International_Classification_of_Diseases_for_Oncologyhttp://www.icd9data.com/getICD9Code.ashx?icd9=170.9http://www.icd9data.com/getICD9Code.ashx?icd9=170.9http://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://en.wikipedia.org/wiki/ICDhttp://en.wikipedia.org/wiki/PAS_stainhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Micrographhttp://en.wikipedia.org/wiki/File%3AEwing_sarcoma_-_PAS_-_very_high_mag.jpghttp://en.wikipedia.org/wiki/File%3AEwing_sarcoma_-_PAS_-_very_high_mag.jpg

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8 Treatment

8.1 Fertility preservation

9 Prognosis

10 References 11 External links

Eponym

James Ewing (18661943) rst described the tumour, establishing that the disease was

separate from lymphoma and other types of cancer known at that time.[4][5]

Causes

Genetic exchange between chromosomes can cause cells to become cancerous. Ewingsarcoma is the result of a translocation between chromosomes 11 and 22, which fuses theEWS gene ofchromosome 22 to the FLI1 gene ofchromosome 11.

EWS/FLI functions as the master regulator.[6]

Other translocations are at t(21;22)[7] and t(7;22).[8]

Clinical ndings

Ewing sarcoma is more common in males and usually presents in childhood or earlyadulthood, with a peak between 10 and 20 years of age. It can occur anywhere in the body,but most commonly in the pelvis and proximal long tubular bones, especially around thegrowth plates. The diaphyses of the femur are the most common sites, followed by the tibiaand the humerus. Thirty percent are overtly metastatic at presentation. Patients usuallyexperience extreme bone pain.

It is positive for CD99 and negative for CD45.[9]

http://en.wikipedia.org/wiki/James_Ewing_(pathologist)http://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/EWS_genehttp://en.wikipedia.org/wiki/Chromosome_22http://en.wikipedia.org/wiki/FLI1http://en.wikipedia.org/wiki/Chromosome_11http://en.wikipedia.org/wiki/Pelvishttp://en.wikipedia.org/wiki/Diaphyseshttp://en.wikipedia.org/wiki/Femurhttp://en.wikipedia.org/wiki/Tibiahttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/CD99http://en.wikipedia.org/wiki/CD45http://en.wikipedia.org/wiki/CD45http://en.wikipedia.org/wiki/CD99http://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Tibiahttp://en.wikipedia.org/wiki/Femurhttp://en.wikipedia.org/wiki/Diaphyseshttp://en.wikipedia.org/wiki/Pelvishttp://en.wikipedia.org/wiki/Chromosome_11http://en.wikipedia.org/wiki/FLI1http://en.wikipedia.org/wiki/Chromosome_22http://en.wikipedia.org/wiki/EWS_genehttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/James_Ewing_(pathologist)

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X-Ray of a

child with

Ewing

sarcoma of

the tibia.

Magnetic resonance imaging

slice showing Ewing's

sarcoma of the left hip (whit

area shown right).

Imaging ndings

On conventional radiographs, the most common osseouspresentation is a permeative lytic lesion with periostealreaction. The classic description of lamellated or "onion skin"

type periosteal reaction is often associated with this lesion.Plain lms add valuable information in the initial evaluation orscreening. The wide zone of transition (e.g. permeative) is themost useful plain lm characteristic in dierentiation of benignversus aggressive or malignant lytic lesions.

MRI should be routinely used in the work-up of malignanttumours. MRI will show the full bony and soft tissue extent andrelate the tumour to other nearby anatomic structures (e.g.vessels). Gadolinium contrast is not necessary as it does notgive additional information over noncontrast studies, thoughsome current researchers argue that dynamic, contrastenhanced MRI may help determine the amount of necrosiswithin the tumour, thus help in determining response totreatment prior to surgery.

CT can also be used to dene the extraosseous extent of thetumour, especially in the skull, spine, ribs and pelvis. Both CTand MRI can be used to follow response to radiation and/orchemotherapy.

Bone scintigraphy can also be used to follow tumour responseto therapy.

In the group of malignant small round cell tumours whichinclude Ewing's sarcoma, bone lymphoma and small cellosteosarcoma, the cortex may appear almost normalradiographically, while there is permeative growth throughoutthe Haversian channels. These tumours may be accompaniedby a large soft tissue mass while there is almost no visiblebone destruction. The radiographs frequently do not shownany signs of cortical destruction.

Clinical dierential diagnosis

Other entities that may have a similar clinical presentationinclude osteomyelitis, osteosarcoma (especially telangiectatic osteosarcoma) and eosinophgranuloma. Soft tissue neoplasms such as pleomorphic undierentiated sarcoma (malignanbrous histiocytoma) that erode into adjacent bone may also have a similar appearance.

http://en.wikipedia.org/wiki/Tibiahttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Radiographyhttp://en.wikipedia.org/wiki/Periosteumhttp://en.wikipedia.org/wiki/Periosteumhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Gadoliniumhttp://en.wikipedia.org/wiki/Computed_axial_tomographyhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Scintigraphyhttp://en.wikipedia.org/wiki/Osteomyelitishttp://en.wikipedia.org/wiki/Osteosarcomahttp://en.wikipedia.org/wiki/Eosinophilic_granulomahttp://en.wikipedia.org/wiki/Eosinophilic_granulomahttp://en.wikipedia.org/wiki/Pleomorphic_undifferentiated_sarcomahttp://en.wikipedia.org/wiki/Pleomorphic_undifferentiated_sarcomahttp://en.wikipedia.org/wiki/Eosinophilic_granulomahttp://en.wikipedia.org/wiki/Eosinophilic_granulomahttp://en.wikipedia.org/wiki/Osteosarcomahttp://en.wikipedia.org/wiki/Osteomyelitishttp://en.wikipedia.org/wiki/Scintigraphyhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Computed_axial_tomographyhttp://en.wikipedia.org/wiki/Gadoliniumhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Periosteumhttp://en.wikipedia.org/wiki/Periosteumhttp://en.wikipedia.org/wiki/Radiographyhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/File%3AEwing's_sarcoma_MRI_nci-vol-1832-300.jpghttp://en.wikipedia.org/wiki/File%3AEwing's_sarcoma_MRI_nci-vol-1832-300.jpghttp://en.wikipedia.org/wiki/Tibiahttp://en.wikipedia.org/wiki/File%3AEwing_sarcoma_tibia_child.jpghttp://en.wikipedia.org/wiki/File%3AEwing_sarcoma_tibia_child.jpg

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Micrograph of a metastatic

Ewing sarcoma with the

characteristic cytoplasmic

clearing on H&E staining,

which was showing to be PA

positive.

Diagnosis

The denitive diagnosis is based on histomorphologic ndings,immunohistochemistry and molecular pathology.

Ewing sarcoma is a small round cell tumor, that typically has aclear cytoplasm on H&E staining, due to glycogen. Thepresence of the glycogen can be demonstrated with positivePAS staining and negative PAS diastase staining. Thecharacteristic immunostain is CD99 which diusely marks thecell membrane. Morphologic and immunohistochemicalndings are corroborated with an associated chromosomaltranslocation, of which there are several. The most commontranslocation, present in approximately 90% of Ewing sarcoma

cases, is t(11;22)(q24;q12).[10][11]

The pathologic dierential diagnosis is the grouping ofsmallround cell tumors, which includes lymphoma, alveolarrhabdomyosarcoma and desmoplastic small round cell tumor, among others.

Epidemiology

The frequency in the United States depends on the patient's age, with a rate of 0.3 case pe1,000,000 children in those younger than 3 years of age to as high as 4.6 cases per1,000,000 in adolescents aged 1519 years. Internationally the annual incidence rate

averages less than 2 cases per 1,000,000 children.[12] In the United Kingdom an average ofsix children per year are diagnosed, mainly males in early stages of puberty. Due to theprevalence of diagnosis during teenage years, there may possibly be a link between the onsof puberty and the early stages of this disease, although no research is currently beingconducted to conrm this hypothesis.

Treatment

Because almost all patients with apparently localized disease at diagnosis have occult

metastatic disease, multidrug chemotherapy (often including ifosfamide and etoposide)[13]

well as local disease control with surgery and/or radiation is indicated in the treatment of al

patients.[14]

Treatment often consists of neo-adjuvant chemotherapy generally followed by a limb salvagor an amputation and may also include radiotherapy. Complete excision at the time of biopsmay be performed if malignancy is conrmed at the time it is examined. Treatment lengths

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vary depending on location and stage of the disease at diagnosis. Radical chemotherapy mbe as short as 6 treatments at 3 week cycles, however most patients will undergochemotherapy for 612 months and radiation therapy for 58 weeks.

Antisense oligodeoxynucleotides have been proposed as possible treatment by down-

regulating the expression of the oncogenic fusion protein associated with the development Ewing sarcoma resulting from the EWS-ETS gene translocation.[15][16] In addition, thesynthetic retinoid derivative fenretinide (4-hydroxy(phenyl)retinamide) has been reported toinduce high levels of cell death in Ewing sarcoma cell lines in vitroand to delay growth of

Ewing sarcoma xenografts in vivomouse models.[17][18]

Fertility preservation

In women, chemotherapy may damage the ovaries and cause infertility. To avail for futurepregnancies, the woman may preserve oocytes or ovarian tissue by oocyte cryopreservatio

or ovarian tissue cryopreservation prior to starting chemotherapy. However, the latter mayreseeding the cancer upon reinsertion of the ovarian tissue.[19] If it is performed, the ovariatissue should be examined for traces of malignancy at both the pathological and molecular

levels prior to the grafting of the cryopreserved tissue.[19]

Prognosis

Staging attempts to distinguish patients with localized from those with metastatic disease.[

Most commonly, metastases occur in the chest, bone and/or bone marrow. Less common sitinclude the central nervous system and lymph nodes.

Five-year survival for localized disease is 70% to 80% when treated with chemotherapy.[21]

Long term survival for metastatic disease can be less than 10% but some sources state it is

25-30%.[22]

References

20. Bone Tumors - Dierential diagnosis (http://www.radiologyassistant.nl/en/494e15cbf0d8. Henk Jan van der Woude and Robin Smithuis.Radiology department of the Onze LieveVrouwe Gasthuis, Amsterdam and the Rijnland hospital,Leiderdorp,the Netherlands.

1. ^ Iwamoto Y (February 2007). "Diagnosis and treatment of Ewing sarcoma"

(http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319) .Jpn. J. Clin. Oncol

37 (2): 7989. doi:10.1093/jjco/hyl142 (http://dx.doi.org/10.1093%2Fjjco%2Fhyl142) .

PMID 17272319 (http://www.ncbi.nlm.nih.gov/pubmed/17272319) . http://jjco.oxfordjournals.or

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http://en.wikipedia.org/wiki/Antisense_oligodeoxynucleotidehttp://en.wikipedia.org/wiki/Ovarieshttp://en.wikipedia.org/wiki/Infertilityhttp://en.wikipedia.org/wiki/Oocyte_cryopreservationhttp://en.wikipedia.org/wiki/Ovarian_tissue_cryopreservationhttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Chemotherapyhttp://www.radiologyassistant.nl/en/494e15cbf0d8dhttp://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1093%2Fjjco%2Fhyl142http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.ncbi.nlm.nih.gov/pubmed/17272319http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://www.ncbi.nlm.nih.gov/pubmed/17272319http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1093%2Fjjco%2Fhyl142http://en.wikipedia.org/wiki/Digital_object_identifierhttp://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://jjco.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17272319http://www.radiologyassistant.nl/en/494e15cbf0d8dhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Ovarian_tissue_cryopreservationhttp://en.wikipedia.org/wiki/Oocyte_cryopreservationhttp://en.wikipedia.org/wiki/Infertilityhttp://en.wikipedia.org/wiki/Ovarieshttp://en.wikipedia.org/wiki/Antisense_oligodeoxynucleotide

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2. ^ Burt M, Karpeh M, Ukoha O, et al. (January 1993). "Medical tumours of the chest wall. Solitar

plasmacytoma and Ewing sarcoma" (http://jtcs.ctsnetjournals.org/cgi/content/abstract/105/1/8

.J. Thorac. Cardiovasc. Surg. 105 (1): 8996. PMID 8419714 (http://www.ncbi.nlm.nih.gov/

pubmed/8419714) . http://jtcs.ctsnetjournals.org/cgi/content/abstract/105/1/89.

3. ^ Longtin R (November 2003). "Ewing sarcoma: a miracle drug waiting to happen?"

(http://jnci.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14600088) .J. Natl. Cancer In

95 (21): 15746. PMID 14600088 (http://www.ncbi.nlm.nih.gov/pubmed/14600088) .

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4. ^ synd/2367 (http://www.whonamedit.com/synd.cfm/2367.html)at Who Named It?

5. ^ Ewing, J. (1921). "Diuse endothelioma of bone". Proceedings of the New York Pathological

Society21: 1724.

6. ^ Owen LA, Kowalewski AA, Lessnick SL (2008). Wu, Xiaolin. ed. "EWS/FLI mediates

transcriptional repression via NKX2.2 during oncogenic transformation in Ewing sarcoma"

(http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001965) . PLoS ONE3 (4): e196

doi:10.1371/journal.pone.0001965 (http://dx.doi.org/10.1371%2Fjournal.pone.0001965) .

PMC 2291578 (http://www.pubmedcentral.gov/

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10.1371/journal.pone.0001965.

7. ^ Sorensen PH, Lessnick SL, Lopez-Terrada D, Liu XF, Triche TJ, Denny CT (February 1994). "A

second Ewing's sarcoma translocation, t(21;22), fuses the EWS gene to another ETS-family

transcription factor, ERG". Nat. Genet. 6 (2): 14651. doi:10.1038/ng0294-146 (http://dx.doi.or

10.1038%2Fng0294-146) . PMID 8162068 (http://www.ncbi.nlm.nih.gov/pubmed/8162068) .

8. ^Jeon IS, Davis JN, Braun BS, et al. (March 1995). "A variant Ewing's sarcoma translocation

(7;22) fuses the EWS gene to the ETS gene ETV1". Oncogene10 (6): 122934. PMID 7700648

(http://www.ncbi.nlm.nih.gov/pubmed/7700648) .

9. ^ Bernstein M, Kovar H, Paulussen M, et al. (May 2006). "Ewing sarcoma family of tumours:

current management" (http://theoncologist.alphamedpress.org/cgi/

pmidlookup?view=long&pmid=16720851) . Oncologist11 (5): 50319. doi:10.1634/

theoncologist.11-5-503 (http://dx.doi.org/10.1634%2Ftheoncologist.11-5-503) . PMID 1672085

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10. ^ URL: http://atlasgeneticsoncology.org/Tumors/Ewing5010.html . Accessed on: 23 February

2010.

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22. ^ http://www.ncbi.nlm.nih.gov/pubmed/15877528

External links

Cancer.Net: Ewing Family of Tumors, Childhood (http://www.cancer.net/patient/

Cancer+Types/Ewings+Family+of+Tumors+-+Childhood)

Ewing family of tumors (http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=322134

entry in the public domain NCI Dictionary of Cancer Terms

Retrieved from "http://en.wikipedia.org/wiki/Ewing%27s_sarcoma "

http://dx.doi.org/10.1093%2Fhumrep%2Fdeq121http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.ncbi.nlm.nih.gov/pubmed/20472912http://www.ncbi.nlm.nih.gov/pubmed/20472912http://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1155%2FSRCM%2F2006%2F83548http://dx.doi.org/10.1155%2FSRCM%2F2006%2F83548http://en.wikipedia.org/wiki/PubMed_Centralhttp://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1698143http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1698143http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.ncbi.nlm.nih.gov/pubmed/17496997http://www.ncbi.nlm.nih.gov/pubmed/17496997http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.ncbi.nlm.nih.gov/pubmed/15877528http://www.cancer.net/patient/Cancer+Types/Ewings+Family+of+Tumors+-+Childhoodhttp://www.cancer.net/patient/Cancer+Types/Ewings+Family+of+Tumors+-+Childhoodhttp://www.cancer.gov/Templates/db_alpha.aspx?CdrID=322134http://en.wikipedia.org/wiki/Ewing%27s_sarcomahttp://en.wikipedia.org/wiki/Ewing%27s_sarcomahttp://www.cancer.gov/Templates/db_alpha.aspx?CdrID=322134http://www.cancer.net/patient/Cancer+Types/Ewings+Family+of+Tumors+-+Childhoodhttp://www.cancer.net/patient/Cancer+Types/Ewings+Family+of+Tumors+-+Childhoodhttp://www.ncbi.nlm.nih.gov/pubmed/15877528http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_Ewings_Family_of_tumors_staged_48.asp?sitearea=http://www.ncbi.nlm.nih.gov/pubmed/17496997http://www.ncbi.nlm.nih.gov/pubmed/17496997http://en.wikipedia.org/wiki/PubMed_Identifierhttp://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1698143http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=1698143http://en.wikipedia.org/wiki/PubMed_Centralhttp://dx.doi.org/10.1155%2FSRCM%2F2006%2F83548http://dx.doi.org/10.1155%2FSRCM%2F2006%2F83548http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/20472912http://www.ncbi.nlm.nih.gov/pubmed/20472912http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1093%2Fhumrep%2Fdeq121

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