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Swellings of this size are unusual in UK clinical practice. This 15 year old boy presented with a swollen left shoulder that had grown slowly over the course of a year, with increasing restriction of movement. On examination, he was malnourished and anaemic. Plain radiographs and magnetic resonance imaging showed a destructive lesion in the left scapula extending into the chest wall. Bone scan and computed tomography of the chest showed no metastases. Histology confirmed a diagnosis of primitive neuroectodermal tumour/Ewing’s sarcoma. He was given two cycles of chemotherapy which significantly decreased the tumour mass in preparation for (possible) surgery. Delay between first symptoms and diagnosis has been reported to be common in Ewing’s sarcoma,1 but we feel this boy’s case to be unusual.
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