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.