Primary Extracranial Ewing Sarcoma Complicated by Hemorrhagic Shock and Multimicrobial Infection: A Diagnostic and Therapeutic Challenge.

Abstract

Ewing sarcoma is a rare malignant neoplasm that is seldom located in the skull or scalp. We describe the case of a 19-year-old previously healthy man presenting with a rapidly growing left parieto-occipital exophytic mass following minor trauma, initially misinterpreted as an abscess. The lesion recurred exponentially with polymicrobial infection and progression to massive extracranial tumoral hemorrhage, culminating in hemorrhagic shock. Surgical excision and histopathological examination confirmed Ewing sarcoma with <i>EWSR1</i> gene rearrangement. Staging revealed pulmonary, lymph node, and bone metastases. Despite the initiation of palliative chemotherapy, the patient experienced rapid tumor progression with recurrent hemorrhage, multiorgan failure, and death. This case highlights the rarity, aggressiveness, and diagnostic complexity of extracranial Ewing sarcoma, emphasizing the importance of a multidisciplinary approach and early molecular confirmation.