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A 46-year-old Arab man developed year-long right chest pain, weight loss, and a firm lower-rib mass. Imaging showed a chest-wall lesion involving ribs 9–11 with diaphragmatic contact; biopsy confirmed Ewing sarcoma. After neoadjuvant chemotherapy, composite en-bloc resection with partial diaphragmatic excision and polypropylene mesh reconstruction was performed, with an R1 anterior margin supporting adjuvant systemic therapy and possible postoperative radiotherapy. ",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/primary-chest-wall-ewing-sarcoma-with-diaphragmatic-invasion-in-an-adult-en-bloc-resection-and-polypropylene-mesh-reconstruction/455182/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/primary-chest-wall-ewing-sarcoma-with-diaphragmatic-invasion-in-an-adult-en-bloc-resection-and-polypropylene-mesh-reconstruction/455182.png","ImageObject",300,407,{"name":92,"@type":93},"pop out","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What imaging findings supported the diagnosis in this adult case?","Question",{"text":112,"@type":113},"Chest X-ray showed a lateral pleural-based opacity, and computed tomography demonstrated a chest-wall lesion involving right ribs 9–11 with contact to the diaphragm.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was Ewing sarcoma confirmed before surgery?",{"text":117,"@type":113},"CT-guided core biopsy confirmed Ewing sarcoma.",{"name":119,"@type":110,"acceptedAnswer":120},"What surgical reconstruction was used after neoadjuvant chemotherapy?",{"text":121,"@type":113},"The patient underwent composite en-bloc resection of ribs 9–11 with partial diaphragmatic excision, stabilized by polypropylene (Prolene) mesh reconstruction.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455182,1791033053,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090760408,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Clinical Case Reports  \nCASE REPORT  OPEN ACCESS   \nPrimary Chest Wall Ewing Sarcoma With Diaphragmatic Invasion in an Adult: En-Bloc Resection and Polypropylene Mesh Reconstruction  \nMohammad Alaa Aldakak1  | Ahmad Al-Bitar1  | Raneem Ahmad2  | Hamza Alhallaq2  | Kinda Assoud2  | Hussain Chaban2  \n1Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic | 2Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic  \nCorrespondence: Mohammad Alaa Aldakak ([alaa.dkak41@gmail.com](alaa.dkak41@gmail.com))  \nReceived: 29 October 2025 | Revised: 10 December 2025 | Accepted: 30 December 2025  \nKeywords: chest wall | diaphragmatic invasion | en bloc resection | Ewing sarcoma | mesh reconstruction  \nABSTRACT  \nChest-wall Ewing sarcoma (CWES) is uncommon in adults and often abuts vital thoracic structures, making R0 resection challenging despite gains with multimodal therapy. A 46-year-old Arab male presented with year-long right-sided chest pain, weight loss, and a firm mass over the lower right ribs. CXR showed a lateral pleural-based opacity; computed tomography (CT) demonstrated a chest-wall lesion involving right ribs 9–11 with diaphragmatic contact. CT-guided core biopsy confirmed Ewing sarcoma. After 4 cycles of neoadjuvant multi-agent chemotherapy, he underwent composite resection of ribs 9–11 with partial diaphragmatic excision and polypropylene (Prolene) mesh reconstruction stabilized by two wires. Pathology revealed a small round blue cell tumor with broad necrosis; margins were negative laterally, posteriorly, and at cartilaginous/diaphragmatic edges, but the anterior margin was positive (R1) . IHC showed diffuse membranous CD99, nuclear FLI1, diffuse vimentin, and focal NSE; molecular confirmation of EWSR1 rearrangement was recommended. This adult CWES with diaphragmatic invasion illustrates the need for multimodal care: induction chemotherapy to address micrometastases and facilitate resection, followed by aggressive local surgery and prosthetic reconstruction. The R1 anterior margin justifies adjuvant systemic therapy with consideration of postoperative radiotherapy to optimize local control. Definitive diagnosis relies on integrated histology, immunophenotype, and molecular testing. Adult CWES may require combined rib and diaphragmatic resection with prosthetic repair. Margin-negative surgery remains pivotal; when margins are positive, tailored adjuvant therapy is essential to mitigate local and micrometastatic risks.  \n1 | Introduction  \nEwing's sarcoma family tumors (ESFT) is a highly aggressive malignant small round blue cell tumor and the second most common primary bone cancer affecting children, adolescents, and young adults [1] . While it can arise in nearly any bone or soft tissue, primary manifestation in the chest wall (CWES) is relatively rare, posing significant diagnostic and therapeutic challenges due to the complex anatomy and proximity to vital  \nthoracic organs [2, 3] . The clinical presentation can be varied, often mimicking more benign conditions, which can, unfortunately, lead to delays in diagnosis [1] . The management of CWES has undergone significant evolution over the past several decades, with survival rates exhibiting marked improvement [4–6] . The current standard of care is a comprehensive, multimodal approach that integrates systemic chemotherapy, surgery, and radiotherapy [5] . Surgical intervention with the goal of complete en bloc resection with negative microscopic  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.  \nClinical Case Reports, 2026; 14:e71824 1 of 6  \n[https://doi.org/10.1002/ccr3.71824](https://doi.org/10.1002/ccr3.71824)  \nKey Clinical Message  \nAdult CWES/PNET may necessitate com","cbCaibLppmMTPuIm","https://ap.wps.com/l/cbCaibLppmMTPuIm","pdf",2154611,"English","# Introduction\n# Case Presentation\n## Case History/Examination","[{\"question\":\"What imaging findings supported the diagnosis in this adult case?\",\"answer\":\"Chest X-ray showed a lateral pleural-based opacity, and computed tomography demonstrated a chest-wall lesion involving right ribs 9–11 with contact to the diaphragm.\"},{\"question\":\"How was Ewing sarcoma confirmed before surgery?\",\"answer\":\"CT-guided core biopsy confirmed Ewing sarcoma.\"},{\"question\":\"What surgical reconstruction was used after neoadjuvant chemotherapy?\",\"answer\":\"The patient underwent composite en-bloc resection of ribs 9–11 with partial diaphragmatic excision, stabilized by polypropylene (Prolene) mesh reconstruction.\"}]","Primary Chest Wall Ewing Sarcoma With Diaphragmatic Invasion in an Adult - En-Bloc Resection and Polypropylene Mesh Reconstruction | PDF",1790742274,15]