METASTATIC EWING CELL-SARCOMA OF THE SINUS AND OSTEOID OSTEOMA OF THEORBIT

PURPOSE: To familiarize ophthalmologists with the management of a ''so litary hot lesion'' on bone scan as part of a metastatic examination. METHODS: Case report of a 27-year-old man with primary Ewing sarcoma o f the fibula. Bone scan as part of a metastatic evaluation showed incr eased uptake in the left orbit. A metastatic lesion could not be ruled out radiologically. RESULTS: A biopsy was performed, and the lesion w as found to be osteoid osteoma; therefore, the patient received only l ocal radiation therapy to the fibula. Eight months later, the patient developed metastatic Ewing cell sarcoma of the sphenoid sinus and subs equently died. CONCLUSIONS: Because of the high,sensitivity but low sp ecificity of bone scan, secondary lesions on bone scan are not necessa rily metastases. A biopsy specimen is often required for pathologic di agnosis.