Current Thoracic Surgery

Ewing’s sarcoma (ES) is a rare form of malignancy that commonly affects the bone. Extraskeletal ES (EES) accounts for 20% of ES cases. The mediastinum is an exceedingly rare primary site of EES and presents with non-specific symptoms that may mimic several other thoracic pathologies. We describe a suspected case of primary mediastinal ES presenting with pneumothorax in a 17-year-old female who presented with chronic cough, dyspnea, and chest pain. The patient had been commenced on empirical treatment for tuberculosis (a common diagnosis in our sub-region) for six weeks before presentation to our facility, due to a lack of improvement in symptoms. Chest computed tomography scan revealed a huge anterior mediastinal mass extending into the left hemithorax with pneumothorax on the right. She underwent a transthoracic percutaneous biopsy, and histological analysis revealed a monomorphic small-round-cell morphology, suggestive of primary mediastinal Ewing’s sarcoma.