Discussion
The most painful late effect of childhood cancers is development of a secondary malignancy. Younger age at the time of ALL diagnosed, radiation exposure, treatment with alkylating agents, anthracyclines and etoposide increase the secondary malignancy risk in children who survived ALL. The most common secondary malignancies are brain tumors and skin cancers (3,6).
A rare situation Ewing sarcoma as a secondary malignancy in survivors of pediatric ALL have reported in few reports and cases are summarized in Table-1. The mean age of patients with EFST who survived ALL was 7.9 ± 4.5 year (range 2.8-16) and the mean latency time between ALL and EFST was 6.0 ± 3.3 year (range 2-12,3) in cases. Three patients were T cell ALL, two patients were pre-B ALL and the phenotype of ALL did not spesify in two patients. Two patients with radiation exposure, whole brain and whole body, had EFST at brain and mandibula, respectively (10). One patient had metastasis to lung and bone at the time EFST diagnosed (5). The ESWL-FL1 gene mutation or rearrengement was found in four of seven patients.
We report a case who survived ALL, had an Askin Tumor eight years after acute leukemia diagnosis. Patients who survived ALL, have been followed-up for long-therm toxicities from childhood to adulthood. In addition to physical examination and blood tests, patients should be evaluated with imaging for secondary malignancies. Early recognized low stage sarcomas have better outcomes than advanced stage. Finally patients who have several different type cancers should be tested for hereditary cancer syndromes.