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Duodenal Ewing´s sarcoma: Unusual location and atypical EWRS-1 translocation.

A 20-year-old woman was admitted, because 5 months before admission, she started having epigastric abdominal pain and lost weight. On examination the patient was pale, had abdominal pain when deep palpation was applied. In laboratory tests, a microcytic hypochromic anemia was found. Results of computed tomography (CT) of the abdomen showed a rounded heterogeneous mass adjacent to the pancreas (Fig. 1). An oral endoscopy revealed in the fourth duodenum portion a neoplastic appearance of an ulcer, where a biopsy was taken (Fig. 2). The pathological and immunohistochemistry studies showed neoplastic cells positive for CD99, FLI-1 (friend leukemia integration 1 transcription factor), and CD 117. With a suspected sarcoma, a molecular study of traslocation t (11; 22), (q24; q12) in the locus 22q12 of EWSR1 gene (Ewing sarcoma breakpoint region 1) was done (Fig. 3). These findings were compatible with Ewing’s sarcoma (ES). The surgery performed was cephalic pancreaticoduodenectomy (Fig. 4).