The muscular skeletal surgical team has had a very successful 2013, which included impressive ewing sarcoma extraction surgeries.   To review their success, we met with Dr. Ahmed Mounir El Sayed, Surgeon in Orthopedics, HGH, to talk about two particular surgeries that where conducted last year.

Nine Year Old Girl – Ewing Sarcoma Extraction
Just before summer of 2013, we were referred a nine year old Indian girl, who was diagnosed with ewing sarcoma in her right ulna (forearm bone).

Ewing sarcoma is the second most common malignant tumor found in children, after osteosarcoma. Ewing can be a fatal cancer if left untreated as it can metastasize to other areas of the body like the lungs or bone marrow resulting in either amputation or death.

“After the cancer was detected, as per protocol, we conducted all necessary investigative work,including MRIs and biopsy of the infected area and held multiple case discussions with multi-disciplinary teams, including pediatric oncology led by Dr. Abdulla Al Nasser, Pediatric Dialysis and many more sub-specialties at HMC and consultation from The Hospital of Sick Children, Toronto,” enlightened Dr Ahmed Mounir.

As part of the treatment process the girl was administered six rounds of chemotherapy to help kill any growing cancer cells and help shrink the malignant cancer to a size that can be removed by surgery.

In July 2013, the girl underwent a 14-hour wide tumor extraction surgery, performed by Dr. Ahmed Mounir and his team of muscular skeletal surgical team. ‘’The surgery was very successful, my team and I were able to completely remove the 15cm tumor with clear surrounding margins, this was confirmed via the tumor specimen testing. The bone was replaced by bone graft from the fibular leg bone,’’ explained Dr. Mounir. “After surgery the girl underwent another six cycles of chemotherapy, which resulted in a good prognosis and to date, seven months after surgery the girl has had no reoccurrence of the tumor’’.

Dr. Mounir spoke on how it will take an estimated six more months before she is able to completely continue on with her normal life, as at the moment she is undergoing extensive occupational therapy to help her through every day routine using her left arm, including to write with her left hand.

14 Year Old Girl – Ewing Sarcoma Extraction
This 14 year old girl was diagnosed with a very rare type of ewing sarcoma that was the first of its kind to be treated here at Hamad General Hospital.

In this particular case the girl had spent approximately one month visiting several places to obtain diagnoses for the cause of her chronic pelvic pain. Only when she came to HMC emergency, did Dr. Mounir’s team receive the call for consultation.

Dr. Mounir told us, ‘’It was only after her MRI, when a large ewing sarcoma was discovered on the right side of her pelvis. It was the first of its kind here at HGH, and also a very rare form that is hard to detect, which explains why it wasn’t detected before.’’

Unlike the above case, this time Dr. Mounir teamed up with a larger MDT team including obs/gyn, Women's Hospital, to discuss the diagnosis option, and as before the patient underwent ix sessions of chemotherapy before her surgery.

‘’This again was a 14 hour surgery, where we removed the malignant tumor, weighing 2.5kg as well as the right half of her pelvis,’’ commented Dr. Mounir. When asked about the reconstructing bone graft, Dr. Mounir’s answer was both shocking yet simple: “Nothing’’.

That’s right, the patient did not have right pelvis replaced after the tumor extract. According to Dr. Mounir, ‘’This was not an easy decision for the parents or my team, but after extensive research of previous cases in the West, it was evident that a patient has the full capability to walk like normal person even after such a section of the pelvis is removed.’’

Nonetheless this did mean the patient had to go through intense physiotherapy post-surgery, as well as other follow up. Dr. Mounir believes post-surgery recovery could take up to one year before the girl can return to her normal routine.

We asked Dr. Mounir about his experience with these two cases and the vision for the future of HMC pediatric muscular skeletal team. ‘’Hamad has a great vision for the future and I personally believe that Hamad has the capability to conduct such surgeries. I have seen an increase in the number of Qataris trusting the system too, which gives us a great moral boost to become bigger and better. These cases we discussed today could not have been successful without the cooperation and collaboration from all the various specialties involved.’’