 Good morning, everyone. I'm Dr. Mohit Sury. My topic for paper presentation is a rare case of even Sakoma under guidance of Dr. Jhala sir. He is a head of the department, SBKS Medical College, Badodra, Gujarat. An overview about this disease. Name came after the founder that is James Eving in 1921, after he observed radio sensitivity in subgroup of bone tumors. In early 1980s, even Sakoma and peripheral primitive neuroectotomal tumor for both found to contain the same reciprocal transducation between 11 and 22. Similar patterns of biochemical on cuisine expression were observed. These tumors were categorized as even Sakoma family of tumors because of the same translocation and similar set of physiology. The frequency of the disease. It is most commonly found in the younger age group that is between the 5 to 20 years of age and rarely above 30 years of age. But still the cases are still infrequent, above 30 years of age. The path of physiology of this disease. Tumors in this family are thought to derive from cells of neurocrest, possibly post-tangly on a cholinergic neuron. The exact cell of the region of even Sakoma family is unknown. The search is still ongoing to further characterize the biology of EWS, FLI1, fusion protein and its role in the transformation cell growth and chemo sensitivity. The focus of most research is the fusion protein-generated form T11-22. Now coming on to the case presentation, a 10-year-old pediatric tumor patient came to the physiology department with complaints of diffuse swelling over the left humerus, which gradually increased in size since 6 months. There was no history of any swelling, no history of any trauma, pain, any restriction of movement, fever and weight loss. We went for a blabbing investigation that all came out of the normal, except ESR and neutrophils were a bit deranged. Then we advised x-rays of left shoulder, AP and lateral view. The diagnosis was expansional latic lesion involving the whole length of the left humerus with complete destruction of cortex, but there was soft tissue shadow seen. There was preservation of the shoulder joint, but there is no calcification or any periostral reaction noted. Lung fields were both normal, so we came up with three differential diagnosis that were aving sarcoma, anorexial bone cyst and vanishing bone disease, that is, coran's disease. Then we advised USG of ebdopelvis and neck. There was no evidence of any ascites or peritoneal lymph node enlargement and no neck node enlargement seen. Then we went for CT scan. CT bone window of coronary and sagittal images showed expansional latic lesion involving the whole length of left humerus with complete destruction of cortex. Shoulder joint would preserve and there was no calcification or any periostral reaction noted. Then we advised for MRI DL spine. MRI pre and post contrast T1 weighted images show lesion, which appeared to be hypo to ISO intent on pre contrast with enhancement of lesion on post contrast images. Then T2 weighted images show lesion to be hyper intense. So on these basis, we can rule out two differential diagnosis in that work. They were on MRI, there were no fluid level so that crosses out the aneurysmal bone cyst diagnosis. And my CT both did not show any, it did not involve any joint and involving the disin bones. So that dis favors vanishing bone tumor coran's disease. So then we went for biopsy and histopathic diagnosis. After five days, the report came back as even psychoma. And the report mentioned the lesion is composed of blasting meters tissue with some differentiated glomerular structures associated with mesenchymal tissue and tissue. They were also sheets of uniform, small round cells sometimes arranged in lobular pattern. The cytoplasm was scanty, pale stain and often waffidate. So coming on to the retrological features of even psychoma on plain film and CT, the parents is very variable, but the tumor still is very aggressive. The common fighting clue, permeative laminated that is onion skill periostal reaction, sclerosis, and often sometimes it shows cordment triangles, speculations or even bone expansion of cystic components. But the soft tissue calcification is very uncommon. On MRI, it shows us on T1 where it go to intermediate signal intensity. Even contrast made it shows heterogeneous but prominent enhancement. And in T2 where heterogeneous signal may see here on end low signal striation on literature. This is the second most common malignant bone tumor in children after osteosarcoma. More common in males than females. And as I said, it occurs more commonly between the age of 5 and 30 years and rare above the age of 30. The location of the tumor is mostly in the medullary cavity, usually of long bones in the lower extremities. Most commonly in long bones in pelvis of the lower part. But they're rarely up, but they can occur in virtually any bone and commonly involves metadiaphysis of the long bones. Thank you. I'm Dr. Mohik Suri, ending of the discussion.