Semin Musculoskelet Radiol 2019; 23(01): 036-057
DOI: 10.1055/s-0038-1676125
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ewing's Sarcoma and Primary Osseous Lymphoma: Spectrum of Imaging Appearances

Marc-André Weber
1   Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
Olympia Papakonstantinou
2   Second Department of Radiology, National and Kapodistrian University of Athens “Attikon” Hospital, Athens, Greece
Violeta Vasilevska Nikodinovska
3   Department of Radiology, University Surgical Clinic “St. Naum Ohridski,” University “Ss. Cyril and Methodius,” Skopje, Macedonia
Filip M. Vanhoenacker
4   Department of Radiology, AZ Sint-Maarten Mechelen, University Hospital Antwerp, Ghent University, Mechelen, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
30 January 2019 (online)


Ewing's sarcoma (ES) is a rare, highly malignant anaplastic stem cell tumor. Histologically, the tumor consists of uniform densely packed small monomorphic cells with round nuclei. The typical appearance at hematoxylin and eosin (H&E) staining is small blue round cells without any matrix formation. On conventional radiography, ES typically presents as a permeative lesion in the diaphysis of a long bone in a child. A large soft tissue component is another characteristic feature, best depicted by magnetic resonance imaging.

Primary osseous lymphomas are most commonly highly malignant B-cell lymphomas. At H&E histologic staining, the tumor stroma consists of diffuse round-cell infiltrates that resembles the appearance of ES. Although there is no typical imaging appearance of an osseous lymphoma, it should be considered in an adult presenting with a Lodwick grade II or III lesion in the metaphysis or diaphysis of a large long bone, the pelvis, or the vertebral column. Histologic confirmation is mandatory.