Diagnostic assessment and interpretation:
Lab investigation including CBC showed anemia. X rays showed
intramedullary lesion at mid shaft femur with onion skin type of
periosteal reaction and multiple drill holes on the cortex (Fig 2). MRI
showed an enhanced heterogeneous mass at shaft of the femur with soft
tissue extension occupying antero- medial and lateral compartment, which
raised a high suspicion of malignant tumor. (Fig 3). Core needle biopsy
was performed and histology revealed Ewing’s sarcoma.