1. A Rare Case of Askin’s Tumor in the 6th rib
Authors
Dr. S Ganesh Kamath
Dr Vasudev B Pai
Dr Kapil Minocha( Presenter)
Dr Sambhram Shetty
Dr. Guruprasad Rai
Kasturba Medical College, Manipal
Manipal University

2. Clinical Presentation
A 23 years old female presented with pain and swelling over right anterior chest. She was afebrile and did not have any other symptoms.
The onset was insidious with progress over 3 months. On examination 7X5 cms oval swelling felt over the anterior chest wall right, anterior axillary line over 6th rib, hard in consistency.
Overlying skin was normal. No other significant findings.

3. Patient positioned supine with slight tilt towards left
Coastal margin
Mass

4. Investigations
Chest X Ray: Soft tissue opacity at the anterior end of 6th rib non homogenous. The lungs were clear.
High resolution computerized tomography Scan, revealed An expansile mixed lytic sclerotic lesion anterior end of 6th rib with periosteal reaction.no infiltration of Right lung. There were two small opacity in the right basal segments less than 1cms.

5. Chest Xray
CT Scan cut section

6. Operative
Specimen

7. Surgery
Patient taken up for Excisional biopsy. The 6th rib was excised with the whole mass with wide margin 4cms to the rib posterior and anteriorly up ti the sternum. There was pleural reaction and lung was not involved
Histopathological Report
Reported as Ewing’s Tumour/ Primitive Neuroectodermal tumour with full clearance

8. Discussion
Askin’s tumor belong to Ewing sarcoma family of Tumour (ESFT)  is a primitive neuroectodermal tumor, developing from the soft tissues of the chest wall. Treatment includes radical surgical resection, neoadjuvant and adjuvant chemotherapy and radiation. The rarity of the lesion requires complex diagnosis approach and a multidisciplinary team with Multimodal chemtherapy treatment.
Significant advances in the neoadjuvant and adjuvant chemotherapeutic regimens, as well as improved facility in diagnosing these tumors through cytogenetic and immunohistochemical analysis, improve long-term disease-free survival.

9. References
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11. Tazi I, Zafad S, Madani A, Harif M, Quessar A, Benchekroun S. Askin tumor: a case report with literature review. Cancer Radiothérapie. 2009;13:771–774. doi: /j.canrad [PubMed] [Cross Ref] :
Kimber C, Michalski A, Spitz L, Pierro A. Primitive neuroectodermal tumours: anatomic location, extent of surgery, and outcome. J Pediatr Surg. Jan 1998;33(1):39-41.
Batsakis JG, Mackay B, el-Naggar AK. Ewing's sarcoma and peripheral primitive neuroectodermal tumor: an interim report. Ann Otol Rhinol Laryngol. Oct 1996;105(10):
Castro EC, Parwani AV. Ewing sarcoma/primitive neuroectodermal tumor of the kidney: two unusual presentations of a rare tumor. Case Report Med. 2012;2012: [Medline]. [Full Text].