Pitfalls in Anatomic Pathology and Clinical Oncology: A Case of Misdiagnosed Pulmonary Ewing Sarcoma as SCLC

Nagham S El Waary^1,2Angelo A Chami¹Doha A Houcheimy¹Jawad K Zrein^1,2*Ryan T Akl¹Francois G Kamar^1,2*

• ¹University of Balamand, Beirut, Lebanon
• ²Mount Lebanon Hospital, Beirut, Lebanon

In oncology, an accurate pathological diagnosis can often mean the difference between cure and failure, potentially leading to a patient's demise. In the case we are presenting a 28-year-old never smoking gentleman, the initial diagnosis of small cell lung cancer was questionable yet confirmed by the anatomic pathology laboratory upon reevaluation. This ultimately led to therapeutic failure following an initial complete remission and likely contributed to the failure of salvage therapy once the diagnosis was corrected to pulmonary Ewing sarcoma. Primary pulmonary Ewing sarcoma is a rare malignancy that is often overlooked in adults. This case underscores not only the striking clinical and histopathological overlap between SCLC and pulmonary Ewing sarcoma, but also the potentially fatal consequences of missing key diagnostic red flags – including the patient's young age, non-smoking status and atypical clinical course. Through this patient's journey we emphasize the importance of multidisciplinary collaboration, the limitations of relying solely on immunohistochemistry and the critical role of early molecular testing. This case serves as a stark reminder that behind every pathology report is a human life, one that depends on vigilance, humility, and thoroughness of the medical team entrusted with their care.