From Obstruction to Oncogenesis: Ewing’s Sarcoma Hidden in the Nasal Cavity

BACKGROUND: Sinonasal tumors in children are uncommon, and the majority are benign. Malignant lesions such as Ewing’s sarcoma are exceedingly rare in this location, accounting for only a small fraction of cases in the head and neck. Because symptoms such as nasal obstruction and discharge can mimic those of inflammatory polyps, diagnosis is often delayed. CASE PRESENTATION: A 16-year-old boy presented with a six-month history of progressive left-sided nasal obstruction, followed by blood-stained mucoid discharge, anosmia, and change in voice. Examination revealed a firm, polypoidal mass filling the left nasal cavity. CT and MRI suggested an angiomatous polyp. The mass was excised endoscopically. Histopathology showed sheets of malignant small round cells with peritheliomatous arrangement, and immunohistochemistry demonstrated diffuse membranous CD99 positivity with nuclear FLI-1 expression, confirming Ewing’s sarcoma. Staging with chest CT, PET scan, and bone marrow biopsy excluded systemic spread, apart from reactive cervical nodes. The patient was treated with multi-agent chemotherapy as per the AEWS1221 protocol, along with local radiotherapy. At one year of follow-up, he remains well and disease-free. CONCLUSION: This case underlines the importance of considering malignant pathology in unilateral nasal polyps in adolescents. Early biopsy is essential for diagnosis, as imaging alone may mimic benign conditions. Combined surgical and oncological management can provide favourable outcomes in sinonasal Ewing’s sarcoma. Key words: Ewing sarcoma; malignancy; nasal polyp; Adolescent;